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BACKGROUND: Transthyretin cardiac amyloidosis (ATTR) is prevalent among patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). We aimed to develop and validate a risk score for predicting ATTR in this context. METHODS: In the prospective multicentre GRECA-TAVI registry, 500 patients with severe AS scheduled for TAVI were screened for ATTR using technetium-99m-labeled DPD or PYP bone scintigraphy in 12 tertiary hospitals, from January 1st to December 31st, 2024. Clinical, echocardiographic, and electrocardiographic variables were recorded. A logistic regression-derived integer-based risk score was developed in a training cohort (n=350) and validated in a validation cohort (n=150). Model performance was evaluated using discrimination, calibration, and decision curve analyses. RESULTS: ATTR was diagnosed in 38 patients (7.6%). Five variables (age, sex, MWT, LVEF, and intracardiac device presence) formed the basis of an 8-point risk score. The score demonstrated good discrimination (AUC=0.75 training, 0.76 validation) and calibration (slope=1.15). A score ≥4 identified patients with a ∼16% ATTR prevalence compared to 2.4% in those with a score <4. This threshold captured most of the ATTR cases (73%) while recommending screening for only 36% of the cohort. Decision curve analysis showed net clinical benefit across clinically relevant thresholds (5-20%) over and above a guideline-recommended approach (based on MWT≥12mm) or a screen-all strategy. CONCLUSIONS: ATTR is common in patients with severe AS undergoing TAVI. A simple bedside score using routinely available variables effectively identifies those patients at risk for ATTR. Selective screening using this tool could improve diagnostic yield and resource allocation.
Antonopoulos et al. (Sun,) studied this question.