Study Finds Checklist Boosts Detection of ATTR-CM

Implementing a checklist based on “red flags” of transthyretin amyloidosis cardiomyopathy (ATTR-CM) can increase the diagnosis of the disease, according to a study presented at ESC Heart Failure 2025.

“(ATTR-CM) is significantly underdiagnosed, as it requires a high index of suspicion. There is often a diagnostic delay, which could be overcome by the identification of “red flags”, as proposed by the ESC. We hypothesized that implementing a Checklist based on those “red-flags” would increase diagnosis of ATTR-CM among Heart Failure (HF) patients under follow-up in specialized units,” the researchers noted.

The study’s primary objective was to compare the detection rate of ATTR-CM both before and after the implementation of a checklist to assess its impact on screening, diagnosis, and outcomes.

In this prospective, multicenter, observational study, researchers analyzed 102 patients (median age, 86; 49% women) with HF and a positive checklist. Any patients with previously diagnosed amyloidosis were excluded from analysis. The investigators recorded clinical, laboratory electrocardiographic, echocardiographic, scintigraphy data, and genetic results. The primary endpoint of interest was analyzed by comparing the diagnosis rates in the two cohorts. Logistic regression analysis was implemented to assess whether ATTR serves as a predictor of outcomes.

The primary comorbidities identified were arterial hypertension (91.2%) and atrial fibrillation/atrial flutter (69.6%). The investigators noted that patients were classified in NHYA-II class (61.8%). Overall, 21.6% of patients were diagnosed with ATTR-CM, with none having a positive genetic test. The researchers further noted that patients with ATTR-CM were notably older (median age 90 vs 84 years, p=0.001), with higher natriuretic peptides and with a significantly increased interventricular septum (IVS), posterior wall thickness, and left ventricular mass index. Following multivariate regression analysis, ATTR-CM did not predict death or readmission at 6 months.

The researchers concluded that using a checklist “revealed a significantly higher prevalence of ATTR-CM (up to 10 times) compared to a retrospective cohort with similar patient characteristics. Some clinical features may increase the index of suspicion.”

Source:

ESC Heart Failure 2025. Abstract #30029. https://esc365.escardio.org/presentation/300209