ASSUMER on PYP Scan for Cardiac Amyloid Typing and Origin: Case-Specific Corroborating Clinical Background and Genetic Analysis

Suspicion for Cardiac Amyloidosis (CA) led a 75-year-old male patient with fatigue, dyspnea, and palpitations to be subjected scintigraphic myocardial investigation technetium-99m-pyrophosphate (99mTc-PYP, or PYP scan) in order distinguish transthyretin-related CA (ATTR) from the light-chain (AL) form. A characteristic anamnesis of bilateral carpal tunnel syndrome, vertebral canal stenosis, senile cataract, as well laboratory, Electrocardiographic (ECG), echocardiographic exploration was compatible positive ATTR scan. Specific features on scan, namely Apical Sparing, more marked Septal Uptake an associated Equivalent cardiac retention, particularly heart-to-contralateral (H/CL) Ratio 1 h 3 pi (“ASSUMER”) were coupled negative genetic analysis, verifying wild-type ATTR. The herein introduced “ASSUMER” scan could hallmark not only amyloid fibril subtype but also origin.