The GRAAL echocardiographic algorithm detected transthyretin amyloid cardiomyopathy with an AUC of 0.90, increasing the C-index by 0.17 compared to the standard guideline score.
Does the GRAAL machine-learning algorithm improve diagnostic accuracy for detecting ATTR-CM on echocardiography compared to standard guideline scores in patients with suspected ATTR-CM?
The GRAAL machine-learning algorithm, utilizing four standard echocardiographic parameters, significantly improves the diagnostic accuracy for detecting ATTR-CM compared to traditional guideline scores.
Absolute Event Rate: 0% vs 0%
Abstract Aims Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure, yet detection remains challenging due to its echocardiographic similarities with age- and hypertension-related cardiac remodelling. Methods and results We retrospectively included 260 patients (76.5 ± 12.9 years old, 59.6% male) referred for suspected ATTR-CM. A supervised machine-learning diagnosis algorithm differentiating patients with (n = 111) and without (n = 149) ATTR-CM based on echocardiographic data, and subsequently validated in an external multicentre cohort of 454 patients (76.3 ± 12.6 years old, 69.1% male). Patients with ATTR-CM had a lower systolic function left ventricular ejection fraction 47 ± 11 vs. 54 ± 12%, P 0.00; global longitudinal strain (GLS) 11.0 ± 3.7 vs. 14.1 ± 4.5%, P 0.001 and more significant relative apical longitudinal sparing (RALS) (1.5 ± 1.2 vs. 0.9 ± 0.4, P 0.001) compared with controls. Machine learning identified right ventricular free wall thickness (RVFWT), RALS, GLS, and LV mass index as key variables for detecting ATTR-CM AUC 0.90 (0.86–0.94); P 0.001. These variables enhanced diagnostic accuracy compared with the increased wall thickness guideline score increase in C-index of 0.17 (0.11–0.23), P 0.001. Diagnostic performance was confirmed in the validation multicentre cohort AUC of 0.83 (0.80–0.87), P 0.001 Conclusion The simple GRAAL algorithm (GLS, RVFWT, Apical spAring, LV Mass) enhances detection accuracy for ATTR-CM and improves patient selection for bone scintigraphy.
Fraix et al. (Wed,) reported a other. The GRAAL echocardiographic algorithm detected transthyretin amyloid cardiomyopathy with an AUC of 0.90, increasing the C-index by 0.17 compared to the standard guideline score.
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