The SAVER screening tool detected cardiac amyloidosis in 2% of aortic stenosis patients with a sensitivity of 82% and specificity of 79% at a score threshold of 11.
Does a structured screening tool based on multiorgan manifestations accurately identify cardiac amyloidosis in patients with aortic stenosis?
A novel scoring system based on clinical, laboratory, and imaging parameters provides a simple and fast approach with high sensitivity and specificity to screen for cardiac amyloidosis in patients with aortic stenosis.
Abstract Aims Combined severe aortic stenosis (AS) and cardiac amyloidosis (CA) are associated with high morbidity and mortality. In recent years, promising new therapies for CA were introduced, and typical diagnostic findings were identified. However, diagnosis of CA, especially in patients with AS, is still often delayed. Purpose The SAVER study aims to establish an easy-to-use CA screening approach to detect AS patients in clinical routine. Methods The prospective SAVER study was conducted from 2021 to 2023 and enrolled patients with AS planned for transcatheter (TAVI) or surgical aortic valve replacement (SAVR). Screening of CA followed a two-step approach. In the initial low-threshold screening, patients were assessed for CA based on 27 typical characteristics according to current literature and recommendations. The assessment included a CA-specific patient’s questionnaire with neurological symptoms and medical history, an electrocardiogram (ECG), an echocardiographic examination, and laboratory measurements of troponin as well as N-terminal pro-B-type natriuretic peptide. Patients with suspected CA were recommended to undergo further diagnostics (DPD scintigraphy or magnetic resonance imaging). In the second step, a multiple regression analysis was conducted to determine the most relevant parameters for identifying patients at risk of CA. Results A total of 1001 patients were enrolled in the SAVER study. Of these, 405 (40%) were identified as at risk for CA, and 204 (20%) underwent further diagnostic evaluation, resulting in 17 confirmed CA cases (2%). Relevant parameters for identifying CA comprised male sex (HR 23.8 (95%CI 2.6; 216.9), p=0.005), carpal tunnel syndrome (HR 5.5 (95%CI 1.4; 22.0), p=0.016), spinal stenosis (HR 4.1 (95%CI 1.1; 14.7), p=0.030), heaviness or numbness of arms or legs (HR 3.8 (95%CI 1.1; 13.3), p=0.034), NT-proBNP (HR 6.7 (95%CI 1.8; 25.3), p=0.004), and sparkling myocardium (HR 4.8 (95%CI 1.3; 17.3), p=0.018). The final screening tool achieved an AUC of 0.89 (95% CI 0.82–0.96). Based on the relevant parameters, a scoring system ranging from 0 to 22 was established. A score of 11 correlated with a sensitivity of 82% and a specificity of 79% and was proposed as the threshold for initiating further diagnostic evaluation. Conclusion The optimized SAVER screening tool is the first interdisciplinary method focusing on CA’s multiorgan manifestations in AS patients. It provides a simple and fast approach to prevent delayed or overlooked diagnosis of CA in AS patients.
Mattig et al. (2025) studied this question. The SAVER screening tool detected cardiac amyloidosis in 2% of aortic stenosis patients with a sensitivity of 82% and specificity of 79% at a score threshold of 11.