Clinical Context

Echocardiography is the principal non-invasive imaging modality for screening cardiac amyloidosis. However, distinguishing CA-associated LVH from other causes of hypertrophy remains challenging in routine clinical practice.

This study aimed to establish a cohort of CA-associated LVH and develop an echocardiographic identification model using readily available parameters.

Study Design

This retrospective nested cohort study included patients from three hospitals between January 1, 2008, and December 31, 2023.

A total of 185 patients with cardiac amyloidosis who underwent 309 echocardiographic examinations were analyzed alongside 1,213 matched data points from non-CA LVH cases. Matching was based on age, gender, and body surface area.

Collected data included clinical variables such as age, gender, anthropometric measures, and history of hypertension, along with echocardiographic parameters related to ventricular dimensions, volumes, function, and structural characteristics, including asymmetric hypertrophy, myocardial echo features, pericardial effusion, and valvular regurgitation.

Key Findings

Multivariable logistic regression identified several independent predictors of cardiac amyloidosis in patients with LVH. These included a history of hypertension (OR: 0.04; 95% CI: 0.021-0.073), left ventricular internal diameter in diastole (OR: 0.927; 95% CI: 0.878-0.977), left ventricular ejection fraction (OR: 0.95; 95% CI: 0.908-0.993), and AMYLI score (OR: 1.088; 95% CI: 1.024-1.161).

Structural and qualitative echocardiographic features were also significant predictors, including asymmetric hypertrophy (OR: 3.729), granular myocardial appearance (OR: 3.111), mild pericardial effusion (OR: 2.77), and mild valvular regurgitation involving the aortic, mitral, and tricuspid valves (OR range: 2.353–4.331).

The developed nomogram demonstrated high diagnostic performance, with overall accuracy ranging from 0.91 to 0.92. Sensitivity ranged from 0.90 to 0.91 and specificity from 0.91 to 0.92. The positive predictive value was 0.73, while the negative predictive value ranged from 0.93 to 0.98. The Youden index ranged from 0.81 to 0.83.

Study Limitations

• Retrospective design with potential for selection bias
• Hospital-based population may limit generalizability
• External validation is required in broader clinical settings

Clinical Perspective

The echocardiographic nomogram demonstrated strong diagnostic performance using routinely available parameters. Its high negative predictive value supports its potential role as a screening tool to exclude cardiac amyloidosis in patients with LVH.

Integration of such models into routine echocardiographic workflows may enhance early detection and guide subsequent diagnostic evaluation.

Key Takeaway

A nomogram based on routine echocardiographic parameters demonstrated high accuracy for identifying cardiac amyloidosis in LVH, supporting its potential role in non-invasive screening.

Author

Vivek Pathak is Founder and Editorial Lead at MedApt, a physician-focused platform covering clinical updates, congress insights, and expert perspectives.