Diagnostic Performance of the Mayo ATTR-CM Score in Diverse Populations

BACKGROUND: The Mayo transthyretin amyloid cardiomyopathy (ATTR-CM) and AMY scores were developed to identify patients at risk for ATTR-CM. However, both were derived largely from White male cohorts with preserved ejection fraction (EF ≥40%) and their performance in more diverse populations is uncertain. OBJECTIVES: The objective of the study was to validate and compare performance of the Mayo ATTR-CM and AMY scores across racially, ethnically, and sex-diverse populations, and across the EF spectrum. METHODS: Two complementary cohorts were evaluated: a Mayo Clinic cardiac amyloid radionuclide imaging referral cohort (n = 1,553; 449 [29%] ATTR-CM) and Screening for Cardiac Amyloidosis With Nuclear Imaging in Minority Populations (SCAN-MP), a prospective community-based study of Black or Caribbean Hispanic individuals (n = 646; 43 [6.6%] ATTR-CM). Scores were calculated as published. Discrimination was assessed using receiver operating characteristic-area under the curve (AUC), with comparisons performed using DeLong's nonparametric method. RESULTS: The Mayo ATTR-CM score demonstrated superior discrimination in both cohorts (AUC: 0.86; 95% CI: 0.84-0.88 Mayo; AUC: 0.81; 95% CI: 0.75-0.87 SCAN-MP) compared with AMY (AUC: 0.67; 95% CI: 0.64-0.70 Mayo; AUC: 0.70; 95% CI: 0.62-0.78 SCAN-MP; DeLong P < 0.001 for both). Performance remained robust among individuals with EF <40% and among women. The AMY score showed lower sensitivity across cohorts. Among individuals exceeding score cutoffs, the probability of ATTR-CM ranged from ∼1 in 2 in the Mayo cohort to ∼1 in 6 in SCAN-MP. CONCLUSIONS: The Mayo ATTR-CM score demonstrates strong, consistent performance across diverse populations, including women, Black, and Hispanic individuals, and those with reduced EF, and outperforms the AMY score. Its reliance on routinely available clinical and echocardiographic data supports automated implementation and may facilitate earlier detection of ATTR-CM.