Usefulness of Sinus of Valsalva Wall Thickness to Predict ^{99 m}Tc-Pyrophosphate Scintigraphy Positivity in Patients With Aortic Stenosis

Abstract

Background: The usefulness of the sinus of Valsalva wall thickness for diagnosing concomitant amyloid cardiomyopathy is not evaluated in patient with aortic stenosis (AS).

Methods and Results: We investigated 70 consecutive patients with moderate to severe AS who underwent ^{99 m}Tc-pyrophosphate (PYP) scintigraphy at Kumamoto University Hospital between 2012 and 2020. The patients were divided into 2 groups based on ^{99 m}Tc-PYP scintigraphy positivity (n=15) or negativity (n=55). The sinus of Valsalva wall thickness and relative apical longitudinal strain (LS) index (RapLSI, apical LS / [basal LS + mid LS]) were significantly associated with ^{99 m}Tc-PYP scintigraphy positivity when adjusted for severe AS (odds ratio [OR] 3.76; 95% confidence interval [CI] 1.36–10.38; P<0.05; and OR 20.7; 95% CI 2.00–215.44; P<0.05, respectively). Receiver-operating characteristic curve analysis showed that the sinus of Valsalva wall thickness had an area under the curve of 0.77 (95% CI 0.63–0.90; P<0.01) for ^{99 m}Tc-PYP scintigraphy positivity and that the best cut-off value was 1.75 mm (sensitivity 87%, specificity 55%). The ^{99 m}Tc-PYP scintigraphy positivity rate in patients with a sinus of Valsalva wall thickness ≥1.75 mm and RapLSI ≥1.0 was 66.7% and the negativity rate in those with a sinus of Valsalva wall thickness <1.75 mm and RapLSI <1.0 was 96.2%.

Conclusions: The sinus of Valsalva wall thickness was useful for predicting ^{99 m}Tc-PYP scintigraphy positivity in patients with AS.