A simple ATTR-CM score to identify transthyretin amyloid cardiomyopathy burden in HFpEF patients

Area of Science:

• Cardiology
• Amyloidosis
• Heart Failure Research

Background:

• Transthyretin amyloid cardiomyopathy (ATTR-CM) is frequently observed in patients diagnosed with heart failure with preserved ejection fraction (HFpEF).
• Limited data currently exists on the prognostic implications of ATTR-CM within the HFpEF population.
• This study aimed to investigate the association between ATTR-CM burden and clinical outcomes in HFpEF patients.

Purpose of the Study:

• To determine if the burden of transthyretin amyloid cardiomyopathy (ATTR-CM) is linked to adverse clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF).
• To assess the predictive value of the ATTR-CM score for clinical outcomes in HFpEF.

Main Methods:

• Utilized data from the TOPCAT trial, analyzing 870 HFpEF patients.
• Employed Cox proportional hazards models and competing risk regression to evaluate associations between baseline ATTR-CM scores and adverse outcomes.
• Assessed the discriminatory ability of the ATTR-CM score using the area under the time-dependent receiver operating characteristic curve (AUC).

Main Results:

• 18.9% of included HFpEF patients had an ATTR-CM score ≥6.
• Each one-point increase in the ATTR-CM score was significantly associated with a higher risk of the primary outcome (adjusted HR 1.19; 95% CI 1.12-1.27).
• Patients with an ATTR-CM score ≥6 exhibited substantially increased risks for the primary outcome (adjusted HR 2.20; 95% CI 1.65-2.95), with moderate predictive ability (AUC 0.652).

Conclusions:

• A simple ATTR-CM scoring system identified an 18.9% prevalence of ATTR-CM in the studied HFpEF cohort.
• Elevated ATTR-CM burden is a potential predictor of adverse clinical outcomes in HFpEF patients.
• The ATTR-CM score demonstrates moderate discriminatory ability for predicting adverse events in this population.