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Upstate offers nuclear scan for heart issue once thought rare

Upstate Medical University now offers nuclear medicine diagnostic scanning for cardiac amyloidosis, a buildup of abnormal proteins in the heart tissue that can lead to heart failure and death but is often misdiagnosed. 

Upstate Chair of Medicine Cynthia Taub, MD, MBA, said early detection of amyloidosis may help halt the progression of the disease, yet many providers are unaware of the condition. Offering the nuclear diagnostic test is just the first step in Taub’s long range plan to make Upstate a key treatment center for the disease.  

“I envision in the next few years that Upstate will become a center of excellence for the diagnosis and treatment of cardiac amyloidosis,” she said. 

Amyloidosis is a systemic condition that can affect joints, the brain, kidneys and eventually the heart. Taub said 20 years ago, it was considered a rare disease but now she said 16 percent of patients who experience heart failure with preserved heart systolic function actually were shown to have cardiac amyloidosis. 

“We didn’t have the awareness in the past, so we didn’t do the screening,” she said. “Given new data in epidemiology and advances in therapeutics, awareness and screening are the first two steps that lead to timely treatment.” 

Taub came to Upstate in August from Dartmouth Health where she was chief of cardiovascular medicine. She is known internationally for her work in clinical applications of advanced echocardiography technologies, valvular heart disease, heart disease in women, and disparity in healthcare delivery. Cardiac amyloidosis is one of her areas of expertise and she brings that interest and awareness to Upstate.  

Since her arrival she and Director of Nuclear Medicine Mary McGrath, MD, have spearheaded an effort to offer a PYP (pyrophosphate) scan—a nuclear scan that can pick up signals in the heart that's been infiltrated by amyloid fibers. 

McGrath said this type of scan can be used for other conditions but until Taub’s arrival it was seldom used at Upstate for cardiac amyloidosis.  

A PYP scan uses a small amount of a radioactive tracer that is injected into the patient’s vein. McGrath said the tracer is attracted to the amyloid deposits and the scan will show activity and uptake in the heart that is not present in people without the disease.  

McGrath described the scan as an intravenous injection that is very attracted to abnormal amyloid deposit in the heart. Imaging is done after one hour and three hours after injection. She said it is a reliable and non-invasive way to diagnose the disease. 

“It is a fairly easy and quick way to suggest the diagnosis with good sensitivity,” she said. 

Taub said routine screening is not recommended for everyone as it requires comprehensive clinical assessment.  

“It is a compilation of clinical signs and symptoms that alert physicians to screen for cardiac amyloidosis,” she said. “ECG and echocardiogram are the initial screening tests.”  

The FDA has approved the first drug to treat the condition and Taub said several more are in development. 

Taub has plans in the works to help raise awareness of the condition. She has invited an expert to speak at Upstate’s cardiology grand rounds this spring and is working on funding to hold a multi-disciplinary symposium as well. She also continues her research with colleagues from Dartmouth and hopes to expand those efforts at Upstate.  

Listen to Taub discuss amyloidosis on the Informed Patient podcast here.

Caption: A collaborative effort between Medicine Chair Cynthia Taub, MD, MBA; Kurt Wilson, chief technologist in Nuclear Medicine; and Mary McGrath, MD, director of Nuclear Medicine, have led to the offer of a PYP (pyrophosphate) scan to aid in the diagnosis of cardiac amyloidosis.