Abstract 4344879: Diagnostic Performance of the ATTR-CM Mayo Score in Black and Hispanic individuals: Findings from SCAN-MP

Abstract

Background: The Mayo transthyretin amyloidosis cardiomyopathy (ATTR-CM) score was developed to screen for ATTR-CM and guide referral for 99mTc-pyrophosphate imaging. However, its performance in Black or Hispanic individuals remains uncertain. Hypothesis: We hypothesize that the Mayo ATTR-CM score will demonstrate similar diagnostic performance in a cohort of self-identified Hispanic and Black patients. Aim: To evaluate the ATTR-CM Mayo score accuracy in the SCAN-MP study (Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations) Methods: SCAN-MP was a prospective, multicenter study designed to evaluate the prevalence and diagnostic strategies for ATTR-CM in at-risk minority populations. ATTR-CM was identified by radionuclide cardiac imaging using single-photon emission computed tomography(SPECT) or endomyocardial biopsy. The Mayo ATTR-CM score was calculated as published. Logistic regression analysis was used to evaluate the performance of the ATTR-CM score to identify patients with ATTR-CM. Model calibration goodness-of-fit was determined by Hosmer-Lemeshow. ROC curves were constructed and sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated. Results: Our cohort included 646 individuals screened for ATTR-CM, of whom 43 (6.7%) were diagnosed with ATTR-CM, with a mean age 80 ± 8 years, 17 (40%) female, 19 (44%) with the V142I variant. Among the 603 (93%) without clinical ATTR-CM, the mean age was 73 ± 9 years, 310 (51%) were female, and 17 (2.8%) carried V142I. An ATTR-CM score of ≥6 had a AUC of 0.79 (95% CI: 0.72-0.86) to discriminate ATTR-CM, with a sensitivity of 64%, specificity of 79%, PPV of 17%, and a NPV of 0.97. The model demonstrated good calibration (χ 2 = 2.97, p = 0.70). Conclusion: The ATTR-CM score is a simple and effective clinical tool to screen for ATTR-CM in self-identified Hispanic and Black patients with heart failure. A score of <6 points confers a high NPV value, thereby useful to exclude ATTR-CM