PYP Scintigraphy in ATTR Cardiac Amyloidosis

TTR amyloid cardiac PYP/DPD scintigraphy revolutionized non-invasive diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). Tc-99m PYP, DPD, or HMDP tracer with 99% sensitivity and 97% specificity. Perugini visual grading 0-3 (Grade 2-3 positive), heart-to-contralateral (H/CL) ratio ≥1.5 diagnostic. With monoclonal protein excluded, it is the only amyloid diagnosis not requiring biopsy. Mandatory screening in elderly males with HFpEF, LV wall thickness >12mm, low-flow low-gradient aortic stenosis, and carpal tunnel syndrome history. Tafamidis reduces mortality by 30%. ESC 2023 amyloidosis guidelines.