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. 2021 Nov 29;9(1):251–262. doi: 10.1002/ehf2.13693

Figure 4.

Figure 4

(A) Representative planar (top) and single‐photon emission computed tomography/computed tomography (SPECT/CT; bottom) images of patients with Grade 1 myocardial tracer uptake and negative monoclonal protein test. White and red arrows indicate cardiac blood pools and positive cardiac uptake, respectively. (B) Flow chart of transthyretin amyloid cardiomyopathy (ATTR‐CM) diagnosis in patients with planar 99mTc‐PYP scintigraphy Grade 1 and a negative monoclonal protein detection test. Endomyocardial, abdominal fat pad, or upper gastrointestinal tract biopsy is recommended. For patients who test negative with a biopsy, it is advisable to schedule regular follow‐up with scintigraphy after 6 months–1 year. Grade 1 in 99mTc‐PYP scintigraphy refers to mild uptake less than rib uptake.