Cardiac amyloidosis (CA) mimics left ventricular hypertrophy (LVH). It is treatable, but its prognosis is poor. A simple screening tool for CA would be valuable. CA is more precisely diagnosed with echocardiographic deformation parameters (e.g., relative apical sparing pattern [RASP]) than with conventional parameters. We aimed to 1) investigate incremental benefits of echocardiographic deformation parameters over established parameters for CA screening; 2) determine the resultant risk score for CA screening; and 3) externally validate the score in LVH patients. We retrospectively studied 295 consecutive non-ischemic LVH patients who underwent detailed diagnostic tests. CA was diagnosed with biopsy or 99mTc-PYP scintigraphy. The base model comprised age (≥65 years [men], ≥70 years [women]), low voltage on the electrocardiogram, and posterior wall thickness ≥ 14 mm in reference to the literature. The incremental benefit of each binarized echocardiographic parameter over the base model was assessed using receiver operating characteristic curve analysis and comparisons of the area under the curve (AUC). Fifty-four (18%) patients had CA. RASP showed the most incremental benefit for CA screening over the base model. After conducting multiple logistic regression analysis for CA screening using four variables (RASP and base model components), a score was determined (range, 0–4 points). The score demonstrated adequate discrimination ability for CA (AUC = 0.86). This result was confirmed in another validation cohort (178 patients, AUC = 0.88). We developed a score incorporating RASP for CA screening. This score is potentially useful in the risk stratification and management of LVH patients.

中文翻译：

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使用相对心尖保留模式对左心室肥厚患者进行心脏淀粉样变性筛查

心脏淀粉样变性 (CA) 类似于左心室肥厚 (LVH)。它是可以治疗的，但它的预后很差。一个简单的 CA 筛选工具将是有价值的。使用超声心动图变形参数（例如，相对心尖保留模式 [RASP]）比使用常规参数更准确地诊断 CA。我们的目标是 1) 研究超声心动图变形参数相对于已建立的 CA 筛查参数的增量优势；2) 确定 CA 筛查的最终风险评分；3) 外部验证 LVH 患者的评分。我们回顾性研究了 295 名接受详细诊断测试的连续非缺血性 LVH 患者。CA 被诊断为活检或 99mTc-PYP 闪烁扫描。基础模型包括年龄（≥65 岁 [男性]，≥70 岁 [女性]）、心电图低电压、后壁厚度≥ 14 mm 参考文献。使用接受者操作特征曲线分析和曲线下面积 (AUC) 的比较来评估每个二值化超声心动图参数相对于基础模型的增量益处。54 名 (18%) 患者患有 CA。RASP 显示出与基本模型相比，CA 筛选的最大优势。在使用四个变量（RASP 和基础模型组件）对 CA 筛选进行多元逻辑回归分析后，确定了一个分数（范围，0-4 分）。该分数证明了对 CA 的足够区分能力（AUC = 0.86）。这一结果在另一个验证队列中得到证实（178 名患者，AUC = 0.88）。我们开发了一个包含 RASP 的分数，用于 CA 筛选。