International journal of cardiology · 2026
Comparison of scoring systems in the identification of transthyretin cardiac amyloidosis in a HFpEF cohort.
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Scully Timothy G, Cai Peishan, Hare James, Nogic Jason, Sajeev Jithin K, Kaye David, Gibbs Simon, Wisniowski Brendan, Ting Stephen B
Аннотация
BACKGROUND: Multiple diagnostic scoring systems have been developed to improve the identification of patients with transthyretin cardiac amyloidosis (ATTR-CA) in patients presenting with heart failure with preserved ejection fraction (HFpEF). The ATTR-CM, AMY, T-Amylo and AMYLI scores have been validated, though data comparing their performance are lacking. We sought to compare the diagnostic accuracy of the scores in an Australian cohort.
METHODS: We conducted a retrospective cohort study across two separate healthcare centres from 2018 to 2024 comprising all patients diagnosed with ATTR-CA and all consecutive patients presenting to a HFpEF clinic who were screened for ATTR-CA. All scores were calculated retrospectively. A multivariable logistic regression model was used to identify significant variables.
RESULTS: A total of 430 patients were included with ATTR-CA being diagnosed in 116 patients (27.0%). The T-Amylo score (area under the curve: 0.895; 95% CI 0.861-0.929) and ATTR-CM score (area under the curve of 0.883; 95% CI 0.847-0.918) both demonstrated very good discriminative capacity for ATTR-CA while the AMY score displayed a moderate discriminative capacity (area under the curve of 0.745; 95% CI 0.689-0.802). In a restricted cohort to patients with increased wall thickness, the AMYLI score displayed a moderate discriminative capacity (area under the curve of 0.777; 95% CI 0.721-0.833).
CONCLUSIONS: Both the ATTR-CM and T-Amylo scores displayed very good performance in identifying patients at high risk for ATTR-CA in patients with known HFpEF.
METHODS: We conducted a retrospective cohort study across two separate healthcare centres from 2018 to 2024 comprising all patients diagnosed with ATTR-CA and all consecutive patients presenting to a HFpEF clinic who were screened for ATTR-CA. All scores were calculated retrospectively. A multivariable logistic regression model was used to identify significant variables.
RESULTS: A total of 430 patients were included with ATTR-CA being diagnosed in 116 patients (27.0%). The T-Amylo score (area under the curve: 0.895; 95% CI 0.861-0.929) and ATTR-CM score (area under the curve of 0.883; 95% CI 0.847-0.918) both demonstrated very good discriminative capacity for ATTR-CA while the AMY score displayed a moderate discriminative capacity (area under the curve of 0.745; 95% CI 0.689-0.802). In a restricted cohort to patients with increased wall thickness, the AMYLI score displayed a moderate discriminative capacity (area under the curve of 0.777; 95% CI 0.721-0.833).
CONCLUSIONS: Both the ATTR-CM and T-Amylo scores displayed very good performance in identifying patients at high risk for ATTR-CA in patients with known HFpEF.