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IWT score for predicting cardiac amyloidosis in patients with hypertensive heart disease

Yuna Matsumoto1, Naoko Ichikawa2,3, Yuina Matsuzawa1

  • 1Clinical Laboratory, St. Luke's International Hospital, Tokyo, Japan.

The International Journal of Cardiovascular Imaging
|September 15, 2025
PubMed

Insights

Half of patients with Hypertensive Heart Disease (HHD) show increased wall thickness (IWT) scores suggesting cardiac amyloidosis (CA). This study identifies key echocardiographic factors influencing these scores in HHD patients.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Echocardiography

Background:

  • Early detection of cardiac amyloidosis (CA) is vital for improving patient prognosis due to recent therapeutic advancements.
  • Increased wall thickness (IWT) scoring, proposed in 2020, aids echocardiographic evaluation for CA.
  • A significant portion of CA patients are initially diagnosed with other cardiomyopathies, like Hypertensive Heart Disease (HHD).

Purpose of the Study:

  • To investigate characteristic IWT score patterns in patients diagnosed with Hypertensive Heart Disease (HHD).
  • To assess the controversy surrounding the use of IWT scores for all patients with left ventricular wall thickening.
  • To identify factors influencing IWT score classification in HHD patients with suspected CA.

Main Methods:

  • Echocardiographic assessment of patients with HHD between August and November 2024.
  • Calculation of IWT scores using transthoracic echocardiography.
  • Logistic regression analysis of mild left ventricular hypertrophy (LVH) cases with IWT scores between 2 and 7 (gray zone) to identify influencing parameters.

Main Results:

  • Out of 121 HHD patients, 51% fell into the suspected CA gray zone based on IWT scores.
  • Systolic apex-to-base ratio (SAB), relative wall thickness (RWT), and TAPSE significantly influenced IWT scores.
  • Modifications to SAB formula and TAPSE cutoff (17 mm) reduced gray zone cases to 29%.

Conclusions:

  • Approximately half of Hypertensive Heart Disease patients exhibit IWT scores that overlap with those suggestive of cardiac amyloidosis.
  • Key echocardiographic parameters like SAB, RWT, and TAPSE are crucial for differentiating HHD from CA in borderline cases.
  • Refining IWT scoring criteria can improve diagnostic accuracy and reduce misclassification in HHD patients.
Abstract

Keywords:
Cardiac amyloidosisEchocardiographyHypertrophyStrain imaging

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