Multiparametric echocardiography scores for transthyretin cardiac amyloidosis diagnosis - is the increased wall thickness score appropriate?

Abstract Introduction Transthyretin cardiac amyloidosis (ATTR-CA) is a restrictive cardiomyopathy increasingly diagnosed in elderly patients (pts) with heart failure. While echocardiography serves as the primary imaging tool, diagnostic challenges often arise in identifying ATTR-CA. Multiparametric echocardiography scores may enhance diagnostic accuracy. Objectives Evaluate the diagnostic accuracy of the Increased Wall Thickness (IWT) score in detecting ATTR-CA among pts referred to a Cardiomyopathy Clinic (CC) at a regional hospital in Portugal for suspected CA. Methods Retrospective single-center study of adult pts followed from 2018 to 2024. The inclusion criteria comprised pts aged 60 yrs or older with left ventricular wall thickness ≥ 12mm and at least one cardiac/extracardiac red flag for CA. We collected data regarding clinical characteristics and the five echocardiographic variables used for calculating the IWT score (Table 1). The IWT score was calculated for all pts, and categorized as low (IWT ≤ 2), intermediate (3 < IWT < 7) and high (IWT ≥ 8) diagnostic probability for ATTR-CA. Pts were classified in the ATTR-CA group (Group 1) and the non-ATTR-CA group (Group 2) according to the ESC algorithm for ATTR-CA diagnosis. Group comparisons were performed. Results 96 pts were included; median age was 79 yrs (IQR 10) and 74 pts (77%) were male. After diagnostic workup, 52 pts (54%) had ATTR-CA confirmed (group 1), of which 51 (98%) had wild-type ATTR-CA. Group 1 pts were older (81 [IQR 8] vs 78 [IQR 10] yrs, p=0.006) and more frequently had overweight (58 vs 32%, p=0.011), hyperuricemia (50 vs 16%, p