Development of a Predictive Tool in Patients With High Pretest Probability for Transthyretin Amyloid Cardiomyopathy | JACC: Advances

0:00I'm Dasha and Brambat, podcast editor for the Jack Advances Team. In the April of 1226 issue, the study, development of a predictive tool in patients with high pre-test probability for transthyretin amyloid cardiomyopathy, is by first author Dr. Chai and senior author Dr. Davis from the University of British Columbia, Canada. Transthyretin amyloid cardiomyopathy is an underdiagnosed cause of heart failure, arrhythmia and valbulid disease. The objective of this study was to develop firstly screening criteria to identify high risk patients for transthyretin amyloid cardiomyopathy and secondly a predictive tool for transthyretin amyloid cardiomyopathy diagnosis. This prospective observational registry from between 2019 and 2022 at two Vancouver academic sites, screen patients aged above 60 presenting two heart failure, atrial fibrillation, transcathered

1:00evolved clinics and cardiologists offices, patients meeting high risk criteria who underwent technician 99 pyrophosphate scans were included, predictors of transthyretin amyloid cardiomyopathy were identified using univariable and multivariable logistic regression. Of 2500 patients screened, 200 were enrolled, with a mean age of 78 years, 65% being male, with a mean follow up of 3 years. Transthyretin amyloid cardiomyopathy was diagnosed in 46, 23% and 7, 3.5% had immunoglobulin like chain amyloidosis, compared to non-transthyretin amyloid cardiomyopathy. Those with transthyretin amyloid cardiomyopathy were older, 83 years versus 77 years, male, 80% versus 60% and at higher anti-probnp, 3633 versus 2018.

2:09Transthyretin amyloid cardiomyopathy patients had a greater posterior wall thickness, 14.5 versus 11.2 mm, low-curus voltages, 37% versus 3.9% and more atrium ventricular block, 38.5% versus 19.2% and higher Doppler E over E prime. A 5 item predictive tool, score greater than or equal to 7 identified patients who had positive transthyretin amyloid cardiomyopathy diagnosis with a sensitivity of 89% and specificity 85% area under the receiver operating characteristic curve 0.931. In conclusion, broad screening criteria of high-risk populations referred for Technician 99 pyrophosphate scans revealed new transthyretin amyloid cardiomyopathy diagnosis in 23%. The predictive tool may guide clinicians in refining pre-test probability and optimizing

3:13diagnosis for transthyretin amyloid cardiomyopathy. Extend evaluation in broader populations is warranted.