临床评分系统在不同患者队列中转甲状腺素淀粉样蛋白心肌病诊断中的表现。

IF 8.2 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Failure Pub Date : 2025-08-01 DOI:10.1016/j.cardfail.2024.11.016

Garred S. Greenberg MD , Chinwendu Onuegbu MD , Carlos Espiche MD , Andrea Scotti MD , Paul Ippolito MD , Henry Dwaah MD , Jake Gilman MS , James Tauras MD , Aldo L. Schenone MD , Piotr J. Slomka PhD , Michelle M. Kittleson MD, PhD , Marcelo F. Di Carli MD , Mario J. Garcia MD , Mark Travin MD , Leandro Slipczuk MD, PhD

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引用次数: 0

摘要

背景：两种诊断性临床评分系统，atr - cm评分和T-AMYLO评分，已被提出，但尚未在不同人群中得到验证，尽管黑人是转甲状腺素淀粉样心肌病（atr - cm）的重要危险因素。本研究的目的是评估他们在不同患者队列中诊断atr - cm的表现。方法：本回顾性单中心研究分析了接受99mtc焦磷酸盐单光子发射计算机断层扫描（Tc-PYP）检查疑似atr - cm的患者。通过单光子发射计算机断层扫描心肌放射性示踪剂摄取证实，Perugini评分为2或3分的患者被认为存在atr - cm。以Tc-PYP为金标准，对多元回归模型和两种评分系统的诊断性能进行检验。结果：我们的队列包括476例患者，其中308例（65%）为非西班牙裔黑人，93例（20%）为西班牙裔，215例（45%）为女性。Tc-PYP阳性164例（34%）。年龄≥74岁、男性、腕管史、lvef2和冠状动脉疾病是Tc-PYP阴性的独立预测因素。多变量模型的曲线下面积（AUC）为0.92 （95% CI, 0.90-0.95）。atr - cm评分(AUC, 0.86；95% CI, 0.83-0.90)的诊断准确性优于T-AMYLO评分(AUC, 0.75；95% ci, 0.71-0.80) （p < 0.001）。结论：两个简单的临床评分系统，用于识别需要进一步诊断评估的atr - cm高风险患者，在我们不同的患者队列中显示出良好的预测准确性。在我们的队列中，atr - cm评分优于T-AMYLO评分。

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Performance of Clinical Scoring Systems in the Diagnosis of Transthyretin Amyloid Cardiomyopathy in a Diverse Patient Cohort

Background

Two diagnostic clinical scoring systems, the ATTR-CM Score and the T-AMYLO Score, have been proposed but not validated in diverse populations despite Black race being an important risk factor for transthyretin amyloid cardiomyopathy (ATTR-CM). The aim of this study was to evaluate their performance in diagnosing ATTR-CM in a diverse patient cohort.

Methods

This retrospective single-center study analyzed patients who underwent a 99mTc-pyrophosphate single-photon emission computed tomography scan (Tc-PYP) for workup of suspected ATTR-CM. ATTR-CM was considered present in those exhibiting Perugini scores of 2 or 3, confirmed by myocardial radiotracer uptake via single-photon emission computed tomography. The diagnostic performance of a multivariate regression model and the two scoring systems was tested against Tc-PYP as the gold standard.

Results

Our cohort included 476 patients, of which 308 (65%) were non-Hispanic Black, 93 (20%) were Hispanic, and 215 (45%) were female. A total of 164 (34%) had a positive Tc-PYP result. Age ≥74 years, male sex, history of carpal tunnel, left ventricular ejection fraction <55%, posterior wall thickness over 12 mm, and relative wall thickness over 0.57 were independent predictors of positive Tc-PYP results in our cohort, and hemoglobin level <10 mg/dL, glomerular filtration rate <30 mL/min/1.73 m², and coronary artery disease were independent predictors of negative Tc-PYP. The multivariate model had an area under the curve (AUC) of 0.92 (95% CI 0.90–0.95). The ATTR-CM Score (AUC, 0.86; 95% CI 0.83–0.90) had better diagnostic accuracy than the T-AMYLO Score (AUC, 0.75; 95% CI 0.71–0.80; P < .001).

Conclusions

Two simple clinical scoring systems, derived to identify patients at high risk of having ATTR-CM necessitating further diagnostic evaluation, showed good predictive accuracy in our diverse patient cohort. The ATTR-CM Score was superior to the T-AMYLO Score in our cohort.

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来源期刊

Journal of Cardiac Failure 医学-心血管系统

CiteScore

7.80

自引率

8.30%

发文量

653

审稿时长

21 days

期刊介绍： Journal of Cardiac Failure publishes original, peer-reviewed communications of scientific excellence and review articles on clinical research, basic human studies, animal studies, and bench research with potential clinical applications to heart failure - pathogenesis, etiology, epidemiology, pathophysiological mechanisms, assessment, prevention, and treatment.