Development and validation of a risk score for transthyretin amyloidosis in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: the GRECA-TAVI registry.
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Antonopoulos Alexios S, Tsampras Theodoros, Kanatas Panagiotis, Ktenopoulos Nikolaos, Koutelou Maria, Panagiotopoulos Ioannis, Kyriakopoulos Dimitrios, Koliastasis Leonidas, Ioannidis Marios, Eftychiou Christos, Iakovou Ioannis, Naka Aikaterini, Gartzonikas Ilias, Lakkas Lampros, Tziakas Dimitrios, Zacharoulis Achilleas, Katsimagklis Georgios, Aznaouridis Konstantinos, Vaina Sophia, Latsios George, Frogoudaki Alexandra, Vakrou Styliani, Rigopoulos Angelos, Ninios Ilias, Oikonomou Evangelos, Maragkoudakis Spyridon, Stamatelopoulos Kimon, Kastritis Efstathios, Filippatos Gerasimos, Kanakakis Ioannis, Kochiadakis George, Michalis Lambros, Vavouranakis Emmanouil, Toutouzas Konstantinos, Tsioufis Konstantinos, Vlachopoulos Charalambos, GREece Cardiac Amyloidosis in Transcatheter Aortic Valve Implantation (GRECA-TAVI) Consortium
Аннотация
METHODS: In the prospective multicenter GRECA-TAVI registry, 500 patients with severe AS scheduled for TAVI were screened for ATTR using technetium-99m-labeled 3,3-diphosphono-1,2-propanodicarboxylic acid or pyrophosphate bone scintigraphy in 12 tertiary hospitals, from January 1 to December 31, 2024. Clinical, echocardiographic, and electrocardiographic variables were recorded. A logistic regression-derived integer-based risk score was developed in a training cohort (n = 350) and validated in a validation cohort (n = 150). Model performance was evaluated using discrimination, calibration, and decision curve analyses.
RESULTS: ATTR was diagnosed in 38 (7.6%) patients. Five variables (age, sex, MWT, left ventricular ejection fraction, and intracardiac device presence) formed the basis of an 8-point risk score. The score demonstrated good discrimination (AUC = 0.75 training, 0.76 validation) and calibration (slope = 1.15). A score ≥4 identified patients with an ∼16% ATTR prevalence compared with 2.4% in those with a score <4. This threshold captured most of the ATTR cases (73%) while recommending screening for only 36% of the cohort. The decision curve analysis showed net clinical benefit across clinically relevant thresholds (5-20%) over and above a guideline-recommended approach (based on MWT ≥12 mm) or a screen-all strategy.
CONCLUSION: ATTR is common in patients with severe AS undergoing TAVI. A simple bedside score using routinely available variables effectively identifies those patients at risk for ATTR. Selective screening using this tool could improve diagnostic yield and resource allocation.