IWT score for predicting cardiac amyloidosis in patients with hypertensive heart disease.

PURPOSE: Early detection and treatment of cardiac amyloidosis (CA) are essential to improve prognosis, following recent therapeutic advances. Therefore, echocardiographic evaluation is crucial, and an increased wall thickness (IWT) score was proposed in 2020. 35% of patients with CA were previously diagnosed with other cardiomyopathies, such as Hypertensive Heart Disease (HHD). However, using the IWT score for all patients with left ventricular wall thickening remains controversial. In this study, we investigated characteristic IWT score patterns in patients with HHD.

METHODS

We assessed patients with HHD who underwent echocardiography between August and November 2024. IWT scores were calculated using transthoracic echocardiography. Two groups were compared: mild and moderate-to-severe left ventricular hypertrophy (LVH). Logistic regression analysis was conducted for mild LVH cases with IWT scores between 2 and 7 points (suspected CA, gray zone) to analyze parameters that influenced this classification.

RESULTS

Among 121 patients (mean age: 60.3 ± 11.5 years), 84 (69%), 23 (19%), and 14 (12%) had mild, moderate and severe LVH, respectively. Sixty-two (51%) patients fell into the gray zone. Significant factors affecting IWT score included the systolic apex-to-base ratio (SAB) (Odds ratio [OR] = 42.4, p < 0.001), relative wall thickness (RWT) (OR = 5.0, p = 0.022), and tricuspid annular plane systolic excursion (TAPSE) (OR = 22.5, p < 0.001). Modifying the SAB formula and establishing a TAPSE cutoff value of 17 mm decreased the number of gray zone cases to 35 (29%).

CONCLUSION

Half of the patients with HHD demonstrated IWT scores consistent with suspected CA.