A Simple Score to Identify Increased Risk of Transthyretin Amyloid Cardiomyopathy in Heart Failure With Preserved Ejection Fraction
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a form of heart failure (HF) with preserved ejection fraction (HFpEF). Technetium Tc 99m pyrophosphate scintigraphy (PYP) enables ATTR-CM diagnosis. It is unclear which patients with HFpEF have sufficient risk of ATTR-CM to warrant PYP. To derive and...
Saved in:
Published in | JAMA cardiology Vol. 7; no. 10; p. 1036 |
---|---|
Main Authors | , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.10.2022
|
Subjects | |
Online Access | Get more information |
Cover
Loading…
Abstract | Transthyretin amyloid cardiomyopathy (ATTR-CM) is a form of heart failure (HF) with preserved ejection fraction (HFpEF). Technetium Tc 99m pyrophosphate scintigraphy (PYP) enables ATTR-CM diagnosis. It is unclear which patients with HFpEF have sufficient risk of ATTR-CM to warrant PYP.
To derive and validate a simple ATTR-CM score to predict increased risk of ATTR-CM in patients with HFpEF.
Retrospective cohort study of 666 patients with HF (ejection fraction ≥ 40%) and suspected ATTR-CM referred for PYP at Mayo Clinic, Rochester, Minnesota, from May 10, 2013, through August 31, 2020. These data were analyzed September 2020 through December 2020. A logistic regression model predictive of ATTR-CM was derived and converted to a point-based ATTR-CM risk score. The score was further validated in a community ATTR-CM epidemiology study of older patients with HFpEF with increased left ventricular wall thickness ([WT] ≥ 12 mm) and in an external (Northwestern University, Chicago, Illinois) HFpEF cohort referred for PYP. Race was self-reported by the participants. In all cohorts, both case patients and control patients were definitively ascertained by PYP scanning and specialist evaluation.
Performance of the derived ATTR-CM score in all cohorts (referral validation, community validation, and external validation) and prevalence of a high-risk ATTR-CM score in 4 multinational HFpEF clinical trials.
Participant cohorts included were referral derivation (n = 416; 13 participants [3%] were Black and 380 participants [94%] were White; ATTR-CM prevalence = 45%), referral validation (n = 250; 12 participants [5%]were Black and 228 participants [93%] were White; ATTR-CM prevalence = 48% ), community validation (n = 286; 5 participants [2%] were Black and 275 participants [96%] were White; ATTR-CM prevalence = 6% ), and external validation (n = 66; 23 participants [37%] were Black and 36 participants [58%] were White; ATTR-CM prevalence = 39%). Score variables included age, male sex, hypertension diagnosis, relative WT more than 0.57, posterior WT of 12 mm or more, and ejection fraction less than 60% (score range -1 to 10). Discrimination (area under the receiver operating characteristic curve [AUC] 0.89; 95% CI, 0.86-0.92; P < .001) and calibration (Hosmer-Lemeshow; χ2 = 4.6; P = .46) were strong. Discrimination (AUC ≥ 0.84; P < .001 for all) and calibration (Hosmer-Lemeshow χ2 = 2.8; P = .84; Hosmer-Lemeshow χ2 = 4.4; P = .35; Hosmer-Lemeshow χ2 = 2.5; P = .78 in referral, community, and external validation cohorts, respectively) were maintained in all validation cohorts. Precision-recall curves and predictive value vs prevalence plots indicated clinically useful classification performance for a score of 6 or more (positive predictive value ≥25%) in clinically relevant ATTR-CM prevalence (≥10% of patients with HFpEF) scenarios. In the HFpEF clinical trials, 11% to 35% of male and 0% to 6% of female patients had a high-risk (≥6) ATTR-CM score.
A simple 6 variable clinical score may be used to guide use of PYP and increase recognition of ATTR-CM among patients with HFpEF in the community. Further validation in larger and more diverse populations is needed. |
---|---|
AbstractList | Transthyretin amyloid cardiomyopathy (ATTR-CM) is a form of heart failure (HF) with preserved ejection fraction (HFpEF). Technetium Tc 99m pyrophosphate scintigraphy (PYP) enables ATTR-CM diagnosis. It is unclear which patients with HFpEF have sufficient risk of ATTR-CM to warrant PYP.
To derive and validate a simple ATTR-CM score to predict increased risk of ATTR-CM in patients with HFpEF.
Retrospective cohort study of 666 patients with HF (ejection fraction ≥ 40%) and suspected ATTR-CM referred for PYP at Mayo Clinic, Rochester, Minnesota, from May 10, 2013, through August 31, 2020. These data were analyzed September 2020 through December 2020. A logistic regression model predictive of ATTR-CM was derived and converted to a point-based ATTR-CM risk score. The score was further validated in a community ATTR-CM epidemiology study of older patients with HFpEF with increased left ventricular wall thickness ([WT] ≥ 12 mm) and in an external (Northwestern University, Chicago, Illinois) HFpEF cohort referred for PYP. Race was self-reported by the participants. In all cohorts, both case patients and control patients were definitively ascertained by PYP scanning and specialist evaluation.
Performance of the derived ATTR-CM score in all cohorts (referral validation, community validation, and external validation) and prevalence of a high-risk ATTR-CM score in 4 multinational HFpEF clinical trials.
Participant cohorts included were referral derivation (n = 416; 13 participants [3%] were Black and 380 participants [94%] were White; ATTR-CM prevalence = 45%), referral validation (n = 250; 12 participants [5%]were Black and 228 participants [93%] were White; ATTR-CM prevalence = 48% ), community validation (n = 286; 5 participants [2%] were Black and 275 participants [96%] were White; ATTR-CM prevalence = 6% ), and external validation (n = 66; 23 participants [37%] were Black and 36 participants [58%] were White; ATTR-CM prevalence = 39%). Score variables included age, male sex, hypertension diagnosis, relative WT more than 0.57, posterior WT of 12 mm or more, and ejection fraction less than 60% (score range -1 to 10). Discrimination (area under the receiver operating characteristic curve [AUC] 0.89; 95% CI, 0.86-0.92; P < .001) and calibration (Hosmer-Lemeshow; χ2 = 4.6; P = .46) were strong. Discrimination (AUC ≥ 0.84; P < .001 for all) and calibration (Hosmer-Lemeshow χ2 = 2.8; P = .84; Hosmer-Lemeshow χ2 = 4.4; P = .35; Hosmer-Lemeshow χ2 = 2.5; P = .78 in referral, community, and external validation cohorts, respectively) were maintained in all validation cohorts. Precision-recall curves and predictive value vs prevalence plots indicated clinically useful classification performance for a score of 6 or more (positive predictive value ≥25%) in clinically relevant ATTR-CM prevalence (≥10% of patients with HFpEF) scenarios. In the HFpEF clinical trials, 11% to 35% of male and 0% to 6% of female patients had a high-risk (≥6) ATTR-CM score.
A simple 6 variable clinical score may be used to guide use of PYP and increase recognition of ATTR-CM among patients with HFpEF in the community. Further validation in larger and more diverse populations is needed. |
Author | Reddy, Yogesh N V Minamisawa, Masatoshi Scott, Christopher G Borlaug, Barry A Davies, Daniel R Dispenzieri, Angela Wehbe, Ramsey M Shah, Sanjiv J Redfield, Margaret M Shah, Amil M Chareonthaitawee, Panithaya Solomon, Scott D AbouEzzeddine, Omar F Grogan, Martha |
Author_xml | – sequence: 1 givenname: Daniel R surname: Davies fullname: Davies, Daniel R organization: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota – sequence: 2 givenname: Margaret M surname: Redfield fullname: Redfield, Margaret M organization: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota – sequence: 3 givenname: Christopher G surname: Scott fullname: Scott, Christopher G organization: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota – sequence: 4 givenname: Masatoshi surname: Minamisawa fullname: Minamisawa, Masatoshi organization: Department of Cardiovascular Medicine, Shinshu University Hospital, Matsumoto, Nagano, Japan – sequence: 5 givenname: Martha surname: Grogan fullname: Grogan, Martha organization: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota – sequence: 6 givenname: Angela surname: Dispenzieri fullname: Dispenzieri, Angela organization: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota – sequence: 7 givenname: Panithaya surname: Chareonthaitawee fullname: Chareonthaitawee, Panithaya organization: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota – sequence: 8 givenname: Amil M surname: Shah fullname: Shah, Amil M organization: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts – sequence: 9 givenname: Sanjiv J surname: Shah fullname: Shah, Sanjiv J organization: Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois – sequence: 10 givenname: Ramsey M surname: Wehbe fullname: Wehbe, Ramsey M organization: Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois – sequence: 11 givenname: Scott D surname: Solomon fullname: Solomon, Scott D organization: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts – sequence: 12 givenname: Yogesh N V surname: Reddy fullname: Reddy, Yogesh N V organization: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota – sequence: 13 givenname: Barry A surname: Borlaug fullname: Borlaug, Barry A organization: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota – sequence: 14 givenname: Omar F surname: AbouEzzeddine fullname: AbouEzzeddine, Omar F organization: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36069809$$D View this record in MEDLINE/PubMed |
BookMark | eNo1kNtKAzEYhIMotta-gUheYGtOe8hlKa0tFBRb8bJkkz80dXezZFNhr31xl6pXMzDDNzB36LrxDSD0QMmMEkKfTqpWWgXj_IwRxmY0L-gVGjNekCRLJR2hadedyFDNpBSc3aIRz0gmCyLH6HuOd65uK8A77QPg6PHGQBOd7fGm0QFUBwa_ue4Te4v3QTVdPPYBomvwvO4r7wxeXMbr3rdqyPCQrEGFiFfKVeeB-eHiEb8G6CB8DbDlCXR0vsGroC7mHt1YVXUw_dMJel8t94t1sn153izm20TxgsbESKl5pgxQWXLBS6GFKHhuU0Z1obm2Zc5ZlpdWGAs2Z1SkzDAx2BQYFCWboMdfbnsuazCHNrhahf7w_wb7AXjQZxg |
CitedBy_id | crossref_primary_10_1007_s12149_023_01878_1 crossref_primary_10_1111_eci_14045 crossref_primary_10_1002_uog_27522 crossref_primary_10_1007_s10741_023_10332_3 crossref_primary_10_1016_j_jchf_2022_11_008 crossref_primary_10_1016_j_cpcardiol_2024_102385 crossref_primary_10_1016_j_labinv_2023_100243 crossref_primary_10_1016_j_jaccao_2024_05_006 crossref_primary_10_1080_13506129_2024_2348681 crossref_primary_10_1161_CIRCULATIONAHA_122_062532 crossref_primary_10_1161_CIRCIMAGING_122_014645 crossref_primary_10_1016_j_jcmg_2023_06_013 crossref_primary_10_1002_ejhf_3339 crossref_primary_10_1002_ejhf_2843 crossref_primary_10_1007_s10741_024_10385_y crossref_primary_10_36660_ijcs_20240047 crossref_primary_10_1001_jama_2024_0442 crossref_primary_10_3390_jcm12062273 crossref_primary_10_1016_j_hfc_2024_03_008 crossref_primary_10_1161_HCI_0000000000000081 crossref_primary_10_1167_tvst_13_2_11 crossref_primary_10_1016_j_ijcard_2023_131598 crossref_primary_10_1016_j_jcmg_2023_05_002 crossref_primary_10_1253_circj_CJ_23_0948 crossref_primary_10_1001_jama_2023_2020 crossref_primary_10_1016_j_cpcardiol_2023_101667 crossref_primary_10_3390_ijms24065680 crossref_primary_10_1002_ejhf_3186 crossref_primary_10_1002_ehf2_14786 |
ContentType | Journal Article |
DBID | CGR CUY CVF ECM EIF NPM |
DOI | 10.1001/jamacardio.2022.1781 |
DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed |
DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) |
DatabaseTitleList | MEDLINE |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
DeliveryMethod | no_fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 2380-6591 |
ExternalDocumentID | 36069809 |
Genre | Journal Article |
GrantInformation_xml | – fundername: NHLBI NIH HHS grantid: K24 HL152008 |
GroupedDBID | 0R~ 53G ABBLC ABJNI ACGFS ADBBV ALMA_UNASSIGNED_HOLDINGS AMJDE ANMPU BCGUY BRYMA C45 CGR CUY CVF EBS ECM EIF H13 NPM OGROG OVD RAJ TEORI |
ID | FETCH-LOGICAL-a381t-d99c36ade19b343b4c44837f521c8c3cfb73267bf4dfef721452d24ef75e2e8b2 |
IngestDate | Tue Aug 27 13:48:57 EDT 2024 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 10 |
Language | English |
LinkModel | OpenURL |
MergedId | FETCHMERGED-LOGICAL-a381t-d99c36ade19b343b4c44837f521c8c3cfb73267bf4dfef721452d24ef75e2e8b2 |
PMID | 36069809 |
ParticipantIDs | pubmed_primary_36069809 |
PublicationCentury | 2000 |
PublicationDate | 2022-10-01 |
PublicationDateYYYYMMDD | 2022-10-01 |
PublicationDate_xml | – month: 10 year: 2022 text: 2022-10-01 day: 01 |
PublicationDecade | 2020 |
PublicationPlace | United States |
PublicationPlace_xml | – name: United States |
PublicationTitle | JAMA cardiology |
PublicationTitleAlternate | JAMA Cardiol |
PublicationYear | 2022 |
SSID | ssj0001699432 |
Score | 2.4158814 |
Snippet | Transthyretin amyloid cardiomyopathy (ATTR-CM) is a form of heart failure (HF) with preserved ejection fraction (HFpEF). Technetium Tc 99m pyrophosphate... |
SourceID | pubmed |
SourceType | Index Database |
StartPage | 1036 |
SubjectTerms | Amyloidosis Cardiomyopathies - diagnostic imaging Cardiomyopathies - epidemiology Female Heart Failure - diagnosis Heart Failure - epidemiology Humans Male Prealbumin Radiopharmaceuticals Retrospective Studies Stroke Volume Technetium Tc 99m Pyrophosphate |
Title | A Simple Score to Identify Increased Risk of Transthyretin Amyloid Cardiomyopathy in Heart Failure With Preserved Ejection Fraction |
URI | https://www.ncbi.nlm.nih.gov/pubmed/36069809 |
Volume | 7 |
hasFullText | |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1La9tAEF6cBkIupc2zT-aQm5GxpZUlHU2JMQXnkAfkFlb7IApYColKSa_9Vf13ndnVyrKT0DQXIbToOZ9mZ5Zv5mPsCINwmaPTC0LDTcBTkQdpNpSBVJHAGZ7HOqJC4fnJeHbBv1_Gl73enw5r6UedD-SvJ-tKXmNVPIZ2pSrZ_7Bse1E8gPtoX9yihXH7IhtP-mfFwrIBqRklhZGu7tY80H9PdHMMJ08b8ridldAsVLZY9icLzNQLRYQPVVSLh4qkiW0N4AyxX_enoiDCOnqN-tryNIgZqfrHN9ppi0_vXEXESnCLDpxaXatiZa2eaPPOGbl69iVH8VSrViLbK-52BI5lQybpNEBYSoHNi1IgRsVP4c6-F3V1f110VzEwAfZ8OJyErLfD0AHz2NhJd3nXnHQROOz42dHQtU15NAEshQfc6w7oZoNR4nRhOpi4XVhQRJjAZant0PCP0bW23H5og20kKbnWk2aZyC7ujbOMR2Fbqum6XK0_0Tbb8ldZS2pscHP-jr1tshKYOIi9Zz1d7rCtecO72GW_J-CQBhZpUFfgkQYt0oCQBpWBFaRBgzRYRRrgiEUaNEgDQhq0SAOPNPBI22MX0-Pzb7Ogke8IBIaBdaCyTEZjofQoyyMe5Vxyki8wGDDKVEbS5AnmDgkxRY02CbXMD1XIcTfWoU7zcJ-9KatSHzJIiDEsMJI0MuYjmWHaEBuVaG011PT4Aztwn-_q1vVoufIf9uOzI5_Y9hKIn9mmQaegv2CEWedfrTX_AlYFgJI |
link.rule.ids | 786 |
linkProvider | National Library of Medicine |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=A+Simple+Score+to+Identify+Increased+Risk+of+Transthyretin+Amyloid+Cardiomyopathy+in+Heart+Failure+With+Preserved+Ejection+Fraction&rft.jtitle=JAMA+cardiology&rft.au=Davies%2C+Daniel+R&rft.au=Redfield%2C+Margaret+M&rft.au=Scott%2C+Christopher+G&rft.au=Minamisawa%2C+Masatoshi&rft.date=2022-10-01&rft.eissn=2380-6591&rft.volume=7&rft.issue=10&rft.spage=1036&rft_id=info:doi/10.1001%2Fjamacardio.2022.1781&rft_id=info%3Apmid%2F36069809&rft_id=info%3Apmid%2F36069809&rft.externalDocID=36069809 |