The Mayo ATTR‐CM score versus other diagnostic scores and cardiac biomarkers in patients with suspected cardiac amyloidosis,European Journal of Heart Failure

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The Mayo ATTR‐CM score versus other diagnostic scores and cardiac biomarkers in patients with suspected cardiac amyloidosis
European Journal of Heart Failure ( IF 16.9 ) Pub Date : 2024-09-10 , DOI: 10.1002/ejhf.3455
Giovanni Battista Bonfioli ₁ , Daniela Tomasoni ₁ , Giuseppe Vergaro _{2,

3} , Vincenzo Castiglione _{2,

3} , Marianna Adamo ₁ , Iacopo Fabiani _{2,

3} , Victor Loghin ₁ , Carlo Mario Lombardi ₁ , Alessio Nicolai ₁ , Marco Metra ₁ , Michele Emdin _{2,

3} , Alberto Aimo _{2,

3}

Affiliation

AimsSeveral scores were developed to help the diagnosis of cardiac amyloidosis (CA). The most recent one, being the Mayo transthyretin amyloidosis cardiomyopathy (ATTR‐CM) score, was not externally validated. We compared the diagnostic performance of the ATTR‐CM score with previous tools (increased wall thickness [IWT] score, AMYLoidosis Index [AMYLI] score, and cardiac biomarkers) in a cohort of patients evaluated for a suspicion of CA.Methods and resultsWe analysed 362 consecutive patients referred to a third‐level centre for suspected CA. Overall, 132 (36%) had transthyretin CA (ATTR‐CA), and 91 (25%) immunoglobulin light chain CA (AL‐CA); CA was excluded in 139 (38%). ATTR‐CM score had a good diagnostic performance to distinguish ATTR‐CA from AL‐CA or no CA, with an area under the curve (AUC) of 0.795 (95% confidence interval [CI] 0.747–0.842, p < 0.001), and ATTR‐CA from no CA (AUC 0.822, 95% CI 0.774–0.871, p < 0.001). Results were consistent in both patients with preserved (AUC 0.787, 95% CI 0.726–0.848, p < 0.001), and reduced or mildly reduced ejection fraction (AUC 0.790, 95% CI 0.709–0.871, p < 0.001). The ATTR‐CM score showed a better discrimination compared to IWT and AMYLI score to distinguish ATTR‐CA from AL‐CA or no CA (p = 0.002), but not to distinguish ATTR‐CA from no CA (p = 0.270). Diagnostic accuracy was significantly higher for the ATTR‐CM score as compared to the rule‐in cut‐off of high‐sensitivity troponin T.ConclusionThe Mayo ATTR‐CM score has a good performance in identifying patients with ATTR‐CA, with also better discrimination power when compared to other scores and biomarkers.

中文翻译：

疑似心脏淀粉样变性患者的 Mayo ATTR-CM 评分与其他诊断评分和心脏生物标志物的比较

目的开发了多种评分来帮助诊断心脏淀粉样变性 (CA)。最近的一项是 Mayo 运甲状腺素蛋白淀粉样变性心肌病 (ATTR-CM) 评分，未经外部验证。我们在一组被评估怀疑患有 CA 的患者中，将 ATTR-CM 评分与之前的工具（增加的壁厚度 [IWT] 评分、淀粉样变性指数 [AMYLI] 评分和心脏生物标志物）的诊断性能进行了比较。方法和结果我们分析了362 名连续患者因疑似 CA 转诊至三级中心。总体而言，132 例 (36%) 患有转甲状腺素蛋白 CA (ATTR-CA)，91 例 (25%) 患有免疫球蛋白轻链 CA (AL-CA)； 139 例 (38%) 中排除了 CA。 ATTR-CM 评分具有良好的诊断性能，可区分 ATTR-CA 与 AL-CA 或无 CA，曲线下面积 (AUC) 为 0.795（95% 置信区间 [CI] 0.747–0.842，p < 0.001），以及来自无 CA 的 ATTR-CA（AUC 0.822，95% CI 0.774–0.871，p < 0.001）。两名射血分数保留（AUC 0.787，95% CI 0.726-0.848，p < 0.001）和射血分数降低或轻度降低（AUC 0.790，95% CI 0.709-0.871，p < 0.001）的患者结果一致。与 IWT 和 AMYLI 评分相比，ATTR-CM 评分显示出更好的区分能力，可区分 ATTR-CA 与 AL-CA 或无 CA (p = 0.002)，但不能区分 ATTR-CA 与无 CA (p = 0.270)。与高敏肌钙蛋白 T 的规则截止值相比，ATTR-CM 评分的诊断准确性显着更高。结论 Mayo ATTR-CM 评分在识别 ATTR-CA 患者方面具有良好的性能，并且具有更好的区分度与其他分数和生物标志物相比的功效。

更新日期：2024-09-10

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