The RAISE score predicted transthyretin-related cardiac amyloidosis with an AUC of 0.69 (95%CI 0.55-0.83, p=0.016) in patients with severe aortic stenosis undergoing TAVR.
Does the RAISE score accurately predict transthyretin-related cardiac amyloidosis in patients with severe aortic stenosis undergoing TAVR?
The RAISE score significantly predicts ATTR in patients with severe aortic stenosis undergoing TAVR, but its discriminative ability (AUC 0.69) is lower than originally reported.
Absolute Event Rate: 0% vs 0%
Abstract Introduction According to recent studies, transthyretin-related cardiac amyloidosis (ATTR) is more prevalent in patients with severe aortic stenosis. Since they are associated with worse prognosis, early diagnosis and specific management is necessary. The RAISE score (left ventricular remodelling, age, myocardial injury, systemic involvement and electrical abnormalities) has been proposed with the aim of early identification of ATTR in this setting with an area under curve of 0.85 (95%CI 0.79-0.91, p0.001) . However, its application has been retrospective and it has not been externally validated. Our objective was to determine the distribution of the RAISE score and to validate its discriminative ability for ATTR in a prospective cohort of patients with severe aortic stenosis referred for TAVR from real clinical practice. Methods Prospective single-centre study in a tertiary hospital. Patients diagnosed with severe aortic stenosis with indication for TAVR were recruited from March 2021 to February 2025. All of them were screened for ATTR by 99mTc-DPD scintigraphy, and were considered diagnostic for ATTR if they had moderate or intense uptake (Perugini grades 2-3) in the abscense of a monoclonal protein that could cause primary amyloidosis on serum chain assay and on immunofixation electrophoresis of blood and urine. Clinical, electrocardiographic, analytical and echocardiographic variables were collected. The RAISE score was calculated in all individuals and we analysed its discriminative power for ATTR. Results A total of 341 patients were analysed, of whom 14 (4.1%) were diagnosed with ATTR. The mean age of the sample was 79 ± 6 years, 72 subjects (21.1%) aged 85 years or older, and 168 individuals of the total (49.3%) were women. The voltage measured by Sokolov-Lyon index was on average 2.15 ± 0.9 mV, being less than 1.9 mV on 85 occasions (24.9%), and we found 36 cases of right bundle branch block (11.2%). 19 patients (5.6%) had carpal tunnel syndrome. The mean interventricular septal thickness was 14 ± 5 mm, and the E/A wave ratio was greater than 1.4 in 30 cases (8.8%). Mean ultrasensitive troponin I levels were 465 ± 5350.35 ng/ml. 216 patients had a RAISE score of 0 or 1, of whom 5 (2.3%) were diagnosed with ATTR; while 125 individuals were classified as RAISE equal to or greater than 2, finding 9 (7.2%) cases of ATTR in this group (p=0.044). We tested the discriminative ability of the ATTR score by ROC curve analysis, showing an area under the curve of 0.69 (95%CI 0.55-0.83, p=0.016). Conclusions In our population, the RAISE score significantly predicted ATTR in patients with severe aortic stenosis. To the best of our knowledge, this study provides the first external validation of the RAISE score in a prospectively recruited sample. Our results suggest a lower discriminative ability for ATTR than the original description.Figure 1.RAISE 0-1 vs RAISE ≥ 2 Figure 2.ROC curve analysis
Guerra et al. (Sat,) reported a other. The RAISE score predicted transthyretin-related cardiac amyloidosis with an AUC of 0.69 (95%CI 0.55-0.83, p=0.016) in patients with severe aortic stenosis undergoing TAVR.