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

Abstract

AbstractBackgroundTransthyretin amyloid cardiomyopathy (ATTR‐CM) is often found in patients with heart failure with preserved ejection fraction (HFpEF). However, the evidence regarding ATTR‐CM and prognosis in HFpEF remains scarce. This study sought to determine whether the ATTR‐CM burden was associated with clinical outcomes in HFpEF patients.MethodsWe evaluated the associations of baseline ATTR‐CM score with adverse outcomes in HFpEF patients from the TOPCAT trial using the Cox proportional hazards model or the competing risk regression model. The discriminatory ability of the ATTR‐CM score was assessed using the area under the time‐dependent receiver operating characteristic curve (AUC).ResultsWe included 870 HFpEF patients, 18.9% of which had an ATTR‐CM score ≥6. Per 1 increment in the ATTR‐CM score was significantly associated with an increased risk of the primary outcome (adjusted hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.12–1.27) with an AUC of 0.652 (0.594–0.711), whereas patients with ATTR‐CM score ≥6 presented higher risks of the primary outcome (adjusted HR 2.20, 95% CI 1.65–2.95). Similar results were observed toward the secondary outcomes.ConclusionsThe simple ATTR‐CM score identified an 18.9% ATTR‐CM burden in HFpEF patients, and a higher ATTR‐CM burden might predict adverse outcomes with moderate discriminatory abilities in HFpEF.