Heart failure & cardiomyopathies
Development of a Predictive Tool in Patients With High Pretest Probability for Transthyretin Amyloid Cardiomyopathy
Authors' conclusion
Broad screening criteria of high-risk populations referred for technetium-99m-pyrophosphate yielded new ATTR-CM diagnoses in 23% of patients. Our predictive tool may guide clinicians in refining pretest probability and optimizing diagnosis for ATTR-CM. External validation in broader populations is warranted.
Study context
- Population
- Patients aged >60 years presenting to heart failure, atrial fibrillation, transcatheter valve clinics, and cardiologists' offices, meeting high-risk criteria and undergoing technetium-99m-pyrophosphateenrolled of 2,500 patients screened, mean follow-up of 3 years
- Participants
- 200 patients
- Exposure
- A 5-item predictive tool for ATTR-CM diagnosis
- ATTR-CMn = 46
Methodological details2 Vancouver academic sites, univariable and multivariable logistic regression
- 2 Vancouver academic sites
- Univariable and multivariable logistic regression
Main finding
As reported in the abstract
ATTR-CM diagnosis
ATTR-CM diagnosed
46
23.0%
Immunoglobulin light-chain amyloidosis
7
3.5%
Observational data: associations, not effects.
Further findings
Age
Male
Low QRS voltages
Atrioventricular block
| Outcome | ATTR-CM | non-ATTR-CM |
|---|---|---|
| NT-proBNP | 3,633 | 2018 |
| Posterior wall thickness | 14.5 ± 3.2 | 11.2 ± 1.8 |
| Doppler E/e' | 18.7 ± 7.6 | 14.4 ± 6.2 |
- Age: P < 0.001
- Male: P = 0.013
- NT-proBNP: P = 0.027
- Posterior wall thickness: P < 0.001
- Low QRS voltages: P < 0.001
- Atrioventricular block: P = 0.018
- Doppler E/e': P = 0.001
Performance of 5-item predictive tool (score ≥7)
- Sensitivity
- 89.1% [95% CI: 80.1%-98.1%]
- Specificity
- 85.1% [95% CI: 70.4%-90.7%]
- Area under receiver operating characteristic curve
- 0.931 [95% CI: 0.884-0.978]
Original publication
Development of a Predictive Tool in Patients With High Pretest Probability for Transthyretin Amyloid Cardiomyopathy. JACC Adv. Published 25 March 2026. doi:10.
Summarised from the published abstract; every number is checked against it