Systematic Echocardiographic Screening Protocol for Cardiac Amyloidosis Detection

BACKGROUND: Cardiac amyloidosis remains critically underdiagnosed, with a median diagnostic time of 2 years, as official echocardiographic reports generally fail to identify high-risk patients. PROJECT RATIONALE: We aimed to identify workflow barriers in patients undergoing echocardiographic assessment, including inconsistent strain imaging application and absence of standardized screening criteria for cardiac amyloidosis at the point of image acquisition. PROJECT SUMMARY: A systematic screening protocol was implemented for early identification of patients at risk for cardiac amyloidosis. We targeted patients ≥65 years (≥60 years for African Americans) with an interventricular septal wall thickness of ≥1.2 cm. Five innovations were implemented: daily technologist-driven screening, educational interventions, holographic visual aids, standardized strain imaging, and structured communication pathways. Among 82 patients screened over 7 months, 48.8% were classified as high risk, with most confirmed cases emerging from this tier. A total of 8 patients demonstrated positive or equivocal pyrophosphate scans, 2 had positive cardiac magnetic resonance imaging, and 2 had a positive biopsy, leading to 6 patients (7.3%) with confirmed cardiac amyloidosis after comprehensive work-up. Notably, 69.5% were identified during noncardiac admissions, where screening would typically be overlooked based on historical data. The protocol increased referrals and achieved meaningful diagnostic yield compared with near-zero detection at baseline. TAKE-HOME MESSAGE: Systematic screening with technologist empowerment and visual reminders dramatically improves cardiac amyloidosis detection, with most cases identified during incidental imaging that would otherwise be missed.