Current issue
Archive
Manuscripts accepted
About the Journal
Editorial office
Editorial board
Section Editors
Abstracting and indexing
Subscription
Contact
Ethical standards and procedures
Most read articles
Instructions for authors
Article Processing Charge (APC)
Regulations of paying article processing charge (APC)
Editor's Choice
CARDIOLOGY / CLINICAL RESEARCH
A simplified cardiac amyloidosis score predicts all-cause and cardiovascular disease mortality and morbidity in the general population: the Ikaria Study
1
First Cardiology Clinic, Hippokration Hospital, School of Medicine, University of Athens, Greece
2
Harokopio University, Athens, Greece
Submission date: 2024-05-15
Final revision date: 2024-08-01
Acceptance date: 2024-08-05
Online publication date: 2024-09-07
Corresponding author
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Transthyretin amyloid cardiomyopathy (ATTR-CM) is an under-appreciated disease. The aim of this study was to evaluate the T-Amylo score, which is related to ATTR-CM, and its association with all-cause and cardiovascular disease (CVD) morbidity and mortality, in the general population.
Material and methods:
The T-Amylo score (range: 0–11) is based on clinical and echocardiographic features (age and gender, interventricular septal end diastole [IVSd] thickness ≥ 16 mm, low QRS interval voltage, and carpal tunnel syndrome) that have been previously introduced in clinical practice. During 2009, 1,420 middle-aged and older inhabitants agreed to enroll in the Ikaria study (678 males aged 67 (14) years, and 742 females aged 66 (14) years); in 2013, the participants were re-evaluated.
Results:
Survival analysis revealed that the T-Amylo score was associated with all-cause mortality (hazard ratio = 1.59, 95% CI: 1.40 to 1.81), and the risk of combined CVD events (1.32, 95% CI: 1.11 to 1.56), after various adjustments were made. ROC analysis revealed that the AUC of T-Amylo score was 0.70, the accuracy was 81.52%, and the net-reclassification indices suggested better reclassification performance than its components. Stratifying by age group, the score predicts all-cause and CVD mortality and morbidity only among individuals aged > 65 years.
Conclusions:
The prognostic value for CVDs of the T-Amylo score observed in this study seems promising, suggesting its applicability in the general population.
Transthyretin amyloid cardiomyopathy (ATTR-CM) is an under-appreciated disease. The aim of this study was to evaluate the T-Amylo score, which is related to ATTR-CM, and its association with all-cause and cardiovascular disease (CVD) morbidity and mortality, in the general population.
Material and methods:
The T-Amylo score (range: 0–11) is based on clinical and echocardiographic features (age and gender, interventricular septal end diastole [IVSd] thickness ≥ 16 mm, low QRS interval voltage, and carpal tunnel syndrome) that have been previously introduced in clinical practice. During 2009, 1,420 middle-aged and older inhabitants agreed to enroll in the Ikaria study (678 males aged 67 (14) years, and 742 females aged 66 (14) years); in 2013, the participants were re-evaluated.
Results:
Survival analysis revealed that the T-Amylo score was associated with all-cause mortality (hazard ratio = 1.59, 95% CI: 1.40 to 1.81), and the risk of combined CVD events (1.32, 95% CI: 1.11 to 1.56), after various adjustments were made. ROC analysis revealed that the AUC of T-Amylo score was 0.70, the accuracy was 81.52%, and the net-reclassification indices suggested better reclassification performance than its components. Stratifying by age group, the score predicts all-cause and CVD mortality and morbidity only among individuals aged > 65 years.
Conclusions:
The prognostic value for CVDs of the T-Amylo score observed in this study seems promising, suggesting its applicability in the general population.
REFERENCES (30)
1.
Maurizi N, Rella V, Fumagalli C, et al. Prevalence of cardiac amyloidosis among adult patients referred to tertiary centres with an initial diagnosis of hypertrophic cardiomyopathy. Int J Cardiol 2020; 300: 191-5.
2.
Medarametla GD, Kahlon RS, Mahitha L, et al. Cardiac amyloidosis: evolving pathogenesis, multimodal diagnostics, and principles of treatment. EXCLI J 2023; 22: 781-808.
3.
Writing Committee; Kittleson MM, Ruberg FL, Ambardekar AV, et al. 2023 ACC Expert Consensus Decision Pathway on Comprehensive Multidisciplinary Care for the Patient With Cardiac Amyloidosis: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2023; 81: 1076-126. Erratum in: J Am Coll Cardiol 2023; 81: 1135.
4.
Obi CA, Mostertz WC, Griffin JM, Judge DP. ATTR epidemiology, genetics, and prognostic factors. Methodist Debakey Cardiovasc J 2022; 18: 17-26.
5.
Ruberg FL, Grogan M, Hanna M, Kelly JW, Maurer MS. Transthyretin amyloid cardiomyopathy: JACC state-of-the-art review. J Am Coll Cardiol 2019; 73: 2872-91.
6.
Yamamoto H, Yokochi T. Transthyretin cardiac amyloidosis: an update on diagnosis and treatment. ESC Heart Fail 2019; 6: 1128-39.
7.
Gillmore JD, Maurer MS, Falk RH, et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation 2016; 133: 2404-12.
8.
Rossi M, Varrà GG, Porcari A, et al. Re-definition of the epidemiology of cardiac amyloidosis. Biomedicines 2022; 10: 1566.
9.
Arana-Achaga X, Goena-Vives C, Villanueva-Benito I, et al. Development and validation of a prediction model and score for transthyretin cardiac amyloidosis diagnosis: T-Amylo. JACC Cardiovasc Imaging 2023; 16: 1567-80.
10.
Papathanasiou G, Georgoudis G, Papandreou M, et al. Reliability measures of the short International Physical Activity Questionnaire (IPAQ) in Greek young adults. Hellenic J Cardiol 2009; 50: 283-94.
11.
Mosteller RD. Simplified calculation of body-surface area. N Engl J Med 1987; 317: 1098.
12.
Chrysohoou C, Pitsavos C, Lazaros G, Skoumas J, Tousoulis D, Stefanadis C; Ikaria Study Investigators. Determinants of all-cause mortality and incidence of cardiovascular disease (2009 to 2013) in older adults: the Ikaria Study of the Blue Zones. Angiology 2016; 67: 541-8.
13.
Chrysohoou C, Skoumas J, Oikonomou E, et al. Aortic artery distensibility shows inverse correlation with heart rate variability in elderly non-hypertensive, cardiovascular disease-free individuals: the Ikaria Study. Heart Vessels 2013; 28: 467-72.
14.
Foscolou A, Chrysohoou C, Dimitriadis K, et al. The association of healthy aging with multimorbidity: IKARIA Study. Nutrients 2021; 13: 1386.
15.
Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 1949; 37: 161-86.
16.
Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P. Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation 1987; 75: 565-72.
17.
Gubner R, Ungerleider HE. Electrocardiographic criteria of left ventricular hypertrophy. Arch Intern Med 1943; 72: 196-209.
18.
Lewis T. Observations upon ventricular hypertrophy with especial reference to preponderance of 1 or other chamber. Heart 1914; 5: 367.
19.
Levy D, Labib SB, Anderson KM, Christiansen JC, Kannel WB, Castelli WP. Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy. Circulation 1990; 81: 815-20.
20.
Molloy TJ, Okin PM, Devereux RB, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage duration product. J Am Coll Cardiol 1992; 20: 1180-6.
21.
Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440-63.
22.
de Simone G, Muiesan ML, Ganau A, et al. Reliability and limitations of echocardiographic measurement of left ventricular mass for risk stratification and follow-up in single patients: the RES trial. Working Group on Heart and Hypertension of the Italian Society of Hypertension. Reliability of M-mode echocardiographic studies. J Hypertens 1999; 17: 1955-63.
23.
Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450-8.
24.
Mancia G, De Backer G, Dominiczak A, et al.; Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105-87.
25.
Cuspidi C, Giudici V, Negri F, et al. Improving cardiovascular risk stratification in essential hypertensive patients by indexing left ventricular mass to height(2.7). J Hypertens 2009; 27: 2465-71.
26.
Tsiachris D, Chrysohoou C, Oikonomou E, et al. Distinct role of electrocardiographic criteria in echocardiographic diagnosis of left ventricular hypertrophy according to age, in the general population: the Ikaria study. J Hypertens 2011; 29: 1624-32.
27.
Ye M, Liu X, Gu Z, et al. A simple ATTR-CM score to identify transthyretin amyloid cardiomyopathy burden in HFpEF patients. Eur J Clin Invest 2023; 53: e14045.
28.
Davies DR, Redfield MM, Scott CG, et al. A simple score to identify increased risk of transthyretin amyloid cardiomyopathy in heart failure with preserved ejection fraction. JAMA Cardiol 2022; 7: 1036-44.
29.
Oghina S, Bougouin W, Bizard M, et al. The impact of patients with cardiac amyloidosis in HFpEF trials. JACC Heart Fail 2021; 9: 169-78.
30.
Bukhari S. Cardiac amyloidosis: state-of-the-art review. J Geriatr Cardiol 2023; 20: 361-75.
Share
RELATED ARTICLE
| eISSN: | 1896-9151 |
| ISSN: | 1734-1922 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
