The RWT/SaVR ratio displayed stronger diagnostic performance to identify ATTR-CM (AUC 0.97) compared with RELAPS (AUC 0.83) and RWT (AUC 0.82) in females with hypertrophied left ventricles.
Case-Control (n=62)
No
Does the RWT/SaVR ratio improve diagnostic accuracy for identifying ATTR-CM compared to conventional echocardiographic red flags in females with left ventricular hypertrophy?
The RWT/SaVR ratio provides excellent diagnostic accuracy (AUC 0.97) for differentiating ATTR-CM from LVH in women, outperforming conventional echocardiographic markers and highlighting the need for sex-specific diagnostic thresholds.
Effect estimate: AUC 0.97
Abstract Aims Transthyretin cardiomyopathy (ATTR-CM) is a progressive, life-threatening infiltrative disorder with reportedly lower prevalence in women. While echocardiographic red flags for identifying ATTR-CM have been established in populations overrepresented by men, their diagnostic utility is inadequately studied in women. We assessed the diagnostic accuracy of echocardiographic red flags and electrocardiography in a well-characterized, female population with hypertrophied left ventricles to differentiate ATTR-CM from left ventricular hypertrophy (LVH). Methods and results We compared echocardiographic red flags and electrocardiography in 62 female patients with an interventricular septal thickness of 12 mm, divided equally into well-defined ATTR-CM (n = 31) and age-matched LVH. ATTR-CM displayed higher relative wall thickness (RWT), higher values for relative apical sparing (RELAPS), and lower S-wave in lead aVR (SaVR) than LVH. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) did not differ between groups. RWT/SaVR ratio displayed stronger diagnostic performance to identify ATTR-CM (AUC = 0.97) when compared with RELAPS (AUC = 0.83) and RWT (AUC = 0.82). Further, RELAPS demonstrated lower and SaVR higher optimal diagnostic cut-offs than those previously published in predominant male cohorts. Conclusion In a well-characterized, single-centre, female population with hypertrophied left ventricles, RWT/SaVR outperformed conventional echocardiographic red flags and shows promise for diagnosing ATTR-CM. Our findings also highlight the need for sex-specific cut-offs, but generalizability is limited by a single-centre design and predominance of the Val30Met genotype. Validation in larger prospective cohorts is warranted.
Lindqvist et al. (Wed,) conducted a case-control in Transthyretin amyloid cardiomyopathy (ATTR-CM) (n=62). RWT/SaVR ratio vs. RELAPS and RWT was evaluated on Diagnostic performance to identify ATTR-CM (AUC 0.97). The RWT/SaVR ratio displayed stronger diagnostic performance to identify ATTR-CM (AUC 0.97) compared with RELAPS (AUC 0.83) and RWT (AUC 0.82) in females with hypertrophied left ventricles.