The Increased Wall Thickness score demonstrated high diagnostic accuracy for detecting ATTR-CA, with an area under the ROC curve of 0.91 (95% CI 0.85-0.97; P<0.001).
Observational (n=96)
No
Does the Increased Wall Thickness (IWT) score accurately diagnose ATTR-CA in elderly patients with suspected cardiac amyloidosis?
The Increased Wall Thickness (IWT) echocardiography score is a highly accurate tool for identifying transthyretin cardiac amyloidosis in elderly patients with suspected disease.
Effect estimate: AUC 0.91 (95% CI 0.85-0.97)
p-value: p=<0.001
Abstract Introduction Transthyretin cardiac amyloidosis (ATTR-CA) is a restrictive cardiomyopathy increasingly diagnosed in elderly patients (pts) with heart failure. While echocardiography serves as the primary imaging tool, diagnostic challenges often arise in identifying ATTR-CA. Multiparametric echocardiography scores may enhance diagnostic accuracy. Objectives Evaluate the diagnostic accuracy of the Increased Wall Thickness (IWT) score in detecting ATTR-CA among pts referred to a Cardiomyopathy Clinic (CC) at a regional hospital in Portugal for suspected CA. Methods Retrospective single-center study of adult pts followed from 2018 to 2024. The inclusion criteria comprised pts aged 60 yrs or older with left ventricular wall thickness ≥ 12mm and at least one cardiac/extracardiac red flag for CA. We collected data regarding clinical characteristics and the five echocardiographic variables used for calculating the IWT score (Table 1). The IWT score was calculated for all pts, and categorized as low (IWT ≤ 2), intermediate (3 IWT 7) and high (IWT ≥ 8) diagnostic probability for ATTR-CA. Pts were classified in the ATTR-CA group (Group 1) and the non-ATTR-CA group (Group 2) according to the ESC algorithm for ATTR-CA diagnosis. Group comparisons were performed. Results 96 pts were included; median age was 79 yrs (IQR 10) and 74 pts (77%) were male. After diagnostic workup, 52 pts (54%) had ATTR-CA confirmed (group 1), of which 51 (98%) had wild-type ATTR-CA. Group 1 pts were older (81 IQR 8 vs 78 IQR 10 yrs, p=0.006) and more frequently had overweight (58 vs 32%, p=0.011), hyperuricemia (50 vs 16%, p0.001) and chronic kidney disease (62 vs 39%, p=0.025). Valvular heart disease was less common in the former group (23% vs 50%, p=0.003). Group 1 pts showed greater interventricular septum thickness (18.5±3.2 vs 15.7±2.8mm, p0.001) and IWT scores (8 IQR 3 vs 4 IQR 4, p0.001). Despite providing intermediate diagnostic probability in a significant proportion of pts, IWT score revealed adequate discrimination value for the presence of ATTR-CA (area under ROC curve 0.91, CI 95% 0.85-0.97, p0.001), with a sensitivity of 67% and specificity of 96% for a score higher than 7.5. Conclusions In our population, the IWT score is a useful predictive tool for ATTR-CA. Given the increasing number of pts referred to our CC, this echocardiographic score could help identify those who should undergo further diagnostic workup to exclude ATTR-CA.
Martins et al. (Thu,) conducted a observational in Suspected transthyretin cardiac amyloidosis (ATTR-CA) (n=96). Increased Wall Thickness (IWT) score was evaluated on Presence of ATTR-CA (AUC 0.91, 95% CI 0.85-0.97, p=<0.001). The Increased Wall Thickness score demonstrated high diagnostic accuracy for detecting ATTR-CA, with an area under the ROC curve of 0.91 (95% CI 0.85-0.97; P<0.001).