EURO-LEARN

EURO-LEARN is project aimed at increasing the awareness of Cardiac Amyloidosis for professionals and patients.

Amyloidosis is the term for a group of rare diseases in which abnormal proteins deposit as amyloid in tissues and organs. Amyloid is produced when abnormal proteins in the body „misfold“ and collect together in various tissues and organs, including the heart. As the amyloid builds up, it starts to cause organ damage, impair quality of life, and this may result in heart failure and arrhythmias.

EURO-LEARN is created to help both professionals and patients to gain more knowledge and awareness of clinical imaging in this field. Most important is to improve the indications and skills of the professional around the bone scanning procedurals for cardiac amyloidosis.

The illness itself

Cardiac amyloidosis is a disorder caused by deposits of an abnormal protein (amyloid) in the heart tissue which make it hard for the heart to work properly.

Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is a gradually progressive and ultimately fatal condition characterised by the deposition of amyloid fibrils from liver-derived transthyretin (TTR) in the myocardial extracellular space. ATTR-CM can be classified as sporadic, associated with the deposition of wild-type transthyretin (ATTRwt), or hereditary, associated with genetic variants of TTR (ATTRv).

Historically there has been a mismatch between the number of clinical diagnoses of ATTR-CM and autopsy findings where cardiac ATTR amyloid deposits have been observed in up to a quarter of elderly individuals. In recent years, greater awareness of ATTR-CM as an under-recognised cause of heart failure, coupled with an ageing population and advances in diagnostic techniques, have resulted in a dramatic increase in new clinical diagnoses of ATTR-CM.

For example, the prevalence of ATTR-CM is currently estimated at ~1 in 7 patients with heart failure with preserved ejection fraction (HFpEF) and 1 in 6 with severe aortic stenosis (AS) requiring transcatheter aortic valve replacement. Based upon these statistics and the growing population of elderly people in Europe (100 million), the prevalence of (unrecognised) ATTR-CM in Europe in this group will increase.

For more information on the disease, please have a look at the following websites:

Groningen Amyloidosis Center of Expertise

Amyloidosis Alliance

Documents Repository

Why is this project so important?

In the past, cardiac amyloidosis was thought to be untreatable and rapidly fatal. However, the field is changing rapidly and the role of bone scintigraphy in cardiac amyloidosis is rising. There are different types of amyloidosis that affect the heart in different ways. Today, many people can expect to survive and experience a good quality of life for several years after diagnosis. It is therefore important to increase the awareness of the disease and treatment options. In addition to “conventional” bone scintigraphy, EURO-LEARN will share new imaging developments and breakthroughs in Cardiac Amyloidosis, such as 18F-SodiumFluoride (NaF) PET and the specific targeting amyloid PET compounds 18F-florbetapir and 18F-flobetaben.

The Purpose

EURO-LEARN aims at increasing the awareness of cardiac amyloidosis in Europe by serving as a centralised hub for all related information, a connecting point for patients and professionals to learn more and exchange experiences. Patients that suffer from cardiac amyloidosis will learn about the bone scanning procedures and medical implications. Professionals will get the chance to browse through various guidelines, documentations and cases as well as to collaborate with each other and gain certification by participating in the eLearning online course on cardiac amyloidosis.

eLearning Course on Cardiac Amyloidosis

With this project we aim to provide a forum for professionals that are involved in the management of patients with Cardiac Amyloidosis (CA) at every stage of their career, where to find a training and awarding opportunity to increase their awareness and improve their practice on the use of nuclear scintigraphy with bone seeking radiopharmaceuticals in the diagnostic work-up along with other multimodality imaging techniques. The focus will lie on transthyretin amyloidosis cardiomyopathy (ATTR-CM). The main focus in this project is Europe as a whole where 99mTc-DPD and 99mTc-HMDP as these are the most widely use radiopharmaceuticals in Europe.

Objectives of the course:

  • To learn when to refer a patient with cardiac amyloidosis to scintigraphy with bone seeking radiopharmaceutical and what to expect from the results of the procedure
  • To learn image acquisition protocols and post-processing of 99mTc-DPD and 99mTc-HMDP scintigraphy and SPECT/CT in Cardiac Amyloidosis
  • To learn visual and semiquantitative image interpretation criteria
  • To learn the standard reporting system of 99mTc-DPD and 99mTc-HMDP scintigraphy and SPECT/CT in Cardiac Amyloidosis
  • To understand imaging pitfalls, recognise false positives and negative findings
  • To improve communication of scan results between referring physician and the patients
  • To provide practical instructions for referring physicians and patients

Target Audience:

  1. Physicians: cardiologists, nuclear medicine physicians, radiologists (including residents) to learn about whole procedurals in bone scintigraphy in cardiac amyloidosis, particular on acquisition, readings and pitfalls.
  2. Technical medicine physicians/medical physicists to optimise the technical aspects of bone scintigraphy in cardiac amyloidosis.
  3. Patients: This project will contribute to timely diagnosis and subsequent treatment of patients with ATTR cardiomyopathy (ATTR-CM), leading to better prognosis.
Phase 1

Module 1

  1. Pre-Assessment with Multiple Choice Questions
  2. Introduction to Cardiac Amyloidosis and New Treatment Options – Hans Nienhuis (Groningen, Netherlands)
  3. Introduction to Cardiac Amyloidosis and Novel Therapeutic Options – Claudio Rapezzi (University of Ferrara – Ferrara, Italy)
  4. Echocardiography and Cardiac MRI in Cardiac Amyloidosis – Olivier Lairez (Toulouse, France)
  5. How to use CMR in Cardiac Amyloidosis – Marianna Fontana (University College London Hospitals – London, UK)
  6. Self-Assessment and Certificate for Module 1
 

Module 2 – Nuclear Medicine Imaging in Cardiac Amyloidosis

  1. Imaging Cardiac Amyloidosis – Sharmila Dorbala (Brigham and Women’s Hospital – Boston, USA)
  2. Nuclear Medicine Application in Amyloidosis: Cardiac MIBG – Protocols, Interpretation, Quantification – Eve Piekarski (Paris, France)
  3. Nuclear Medicine Application in Amyloidosis – New PET Radiopharmaceuticals in Cardiac Amyloidosis, Perspectives – Jens Sörensen (Uppsala, Sweden)
  4. Cardiac Bone Scans – Protocols, Interpretation, Quantification: an Overview – Riemer Slart (Groningen, Netherlands)
  5. Self-Assessment and Certificate for Module 2
Phase 2

Module 3 – Case examples of Modules 1 and 2

  1. Case 1 – Riemer Slart
  2. Case 2 – Riemer Slart
  3. Case 3 – Alessia Gimelli
  4. Case 4 – Hans Nienhuis
  5. Case 5 – Hans Nienhuis
  6. Case 6 – Hans Nienhuis
  7. Case 7 – Hans Nienhuis
  8. Self-Assessment and Certificate for Module 3

Module 4 – Radiopharmaceuticals for Clinical Amyloidosis

  1. General overview: What is available?
  2. Bone seeking radiopharmaceuticals: secret of localisation and biodistribution and practical aspects of preparation and quality controls
  3. Self-Assessment and Certificate for Module 4

Module 5 – Nuclear Medicine Imaging in Cardiac Amyloidosis

  1. Case 1 – Alessia Gimelli
  2. Case 2 – Riemer Slart
  3. Case 3 – Riemer Slart
  4. Case 4 – Riemer Slart
  5. Case 5 – Alessia Gimelli
  6. Case 6 – Alessia Gimelli
  7. Self-Assessment and Certificate for Module 5

Module 6 – Imaging acquisition and reading

  1. Protocol for bone scintigraphy in cardiac amyloidosis – Riemer Slart
  2. Planar and SPECT, visual and semiquantitative and quantitative – Alessia Gimelli
  3. SPECT Evaluation for ATTR Cardiac Amyloidosis – Alessia Gimelli
  4. Results EU questionnaire on cardiac amyloidosis and cardiac sarcoidosis – Alessia Gimelli
  5. Self-Assessment and Certificate for Module 6

Phase 3

Module 7 – Clinical Cases and Multimodality Imaging

  1. Case 1 – Riemer Slart and Hans Nienhuis
  2. Case 2 – Riemer Slart and Hans Nienhuis
  3. Case 3 – Riemer Slart and Hans Nienhuis
  4. Case 4 – Riemer Slart and Hans Nienhuis
  5. Indication to bone scan in Cardiac Amyloidosis and patient selection – Riemer Slart
  6. Self-Assessment and Certificate for Module 7

Module 8

  1. How to integrate bone scan in the clinical workout –  Alessia Gimelli
  2. Case 1 – Riemer Slart and Hans Nienhuis
  3. Case 2 – Riemer Slart and Hans Nienhuis
  4. Self-Assessment and Certificate for Module 8

Phase 4

Module 9

  1. Therapy – discussing the principle of therapy in amyloidosis – Melissa A. Lyle
  2. Patient Selection for treatment initiation with a special emphasis on the role of imaging – Amelia Jimenez Heffernan
  3. The role of clinical parametres and biomarkers and the role of imaging in treatment monitoring –  Francesco Bandera
  4. When to use which treatment in which patient – 2 case discussions
  5. Self-Assessment and Certificate for Module 9

Phase 5

Module 10

  1. ATTR Cardiac Amyloidosis: Exploring the Frontier of Diagnosis and Management  – Wael Jaber and Alice Haouzi
  2. Case study on PiB PET Case – Riemer Slart
  3. Self-Assessment and Certificate for Module 10

Final Assessment

This freely accessible course is available online on the ESMIT eLearning platform. 

It is self-paced and can be taken at any time. After successful completion of modules, an ESMIT certificate is granted.

To sign up for the course, please follow these steps:

  1. Sign in to your myEANM account or create a new account.
  2. Click on ESMIT and then on “ESMIT Registrations”.
  3. This will bring you directly to the eLearning platform.
  4. Once logged in, click on EURO-LEARN and enrol for free.