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Multiparametric echocardiography scores for transthyretin cardiac amyloidosis diagnosis – is the increased wall thickness score appropriate?
Session:
SESSÃO DE POSTERS 06 - AMILOIDOSE CARDÍACA
Speaker:
André Manuel Martins
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.3 Myocardial Disease – Diagnostic Methods
Session Type:
Cartazes
FP Number:
---
Authors:
André Manuel Faustino Martins; Mónica Amado; Joana Pereira; Adriana Vazão; Carolina Gonçalves; Mariana Carvalho; Margarida Cabral; Célia Domingues; Catarina Ruivo; Hélia Martins
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>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.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objectives:</strong> 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.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong> 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. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> 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%, p<0.001) 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 (<span style="color:black">18.5±3.2 vs </span>15.7±2.8mm, p<0.001) and IWT scores (8[IQR 3] vs 4[IQR 4], p<0.001). 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, p<0.001), with a sensitivity of 67% and specificity of 96% for a score higher than 7.5.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions:</strong> 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.</span></span></span></p>
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