A staging system using echocardiogram readings may help identify the risk level of patients with transthyretin amyloid cardiomyopathy (ATTR-CM), according to a recent study published in JACC: Advances.
Many of the existing risk prediction models for ATTR-CM rely primarily on biomarkers found in the blood, but they don’t show all the structural and functional changes affecting the heart.
Read more about ATTR-CM prognosis and staging
Echocardiograms are noninvasive tests that create images of the heart using sound waves. The multicenter Italian study included 293 individuals diagnosed with ATTR-CM between 2017 and 2023. The authors classified participants as low risk, moderate risk or high risk using two measurements taken during echocardiograms: stroke volume index (SVi) and systolic pulmonary artery pressure (sPAP). Together, these measures show how well the heart is pumping blood and whether the pressure needed to fill the heart chambers is elevated.
Participants in the low risk group had the lowest heart rate at baseline and the lowest prevalence of atrial fibrillation or flutter history. The proportion of patients with New York Heart Association (NYHA) Functional Class III or IV disease, indicating moderate to severe heart failure, increased from 12.2% in the low risk group to 53% in the high risk group.
In total, 123 patients (42%) reported receiving a disease-modifying therapy, the most common of which was tafamidis. Use of disease-modifying therapies steadily decreased with rising risk level.
The study followed participants for about 20 months on average. During this time, 108 (37%) patients experienced all-cause death or heart failure hospitalization.
After adjusting for age, sex and length of time on disease-modifying therapy, moderate-risk patients had 1.70 times the rate of this outcome compared with low-risk patients, and high-risk patients had 2.50 times the rate compared with low-risk patients.
“The noninvasive hemodynamic approach provides an alternative and promising method to stratify the risk of clinical outcome in patients with ATTR-CM, potentially improving management strategies,” the authors concluded.
Future studies may seek to integrate biomarkers or more echocardiogram parameters or to further refine risk prediction models.
