Prospective Systematic Screening for Transthyretin Amyloid Cardiomyopathy in Cardiology Inpatients With Left Ventricular Hypertrophy: the IMPACT Study

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Publication Details

Journal
European Heart Journal - Cardiovascular Imaging
Published
2026-09-14
DOI
https://doi.org/10.1093/ehjci/jeag254
Primary Topic
Amyloidosis: Diagnosis, Treatment, Outcomes
Type
article
Field-Weighted Citation Impact
0.00
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article

Prospective Systematic Screening for Transthyretin Amyloid Cardiomyopathy in Cardiology Inpatients With Left Ventricular Hypertrophy: the IMPACT Study

Pierre‐Jean Saulnier, Claire Bouleti, Benjamin Alos, Maxime Doublet et al.
European Heart Journal - Cardiovascular Imaging
Amyloidosis: Diagnosis, Treatment, Outcomes
article

Prospective Systematic Screening for Transthyretin Amyloid Cardiomyopathy in Cardiology Inpatients With Left Ventricular Hypertrophy: the IMPACT Study

Pierre‐Jean Saulnier, Claire Bouleti, Benjamin Alos, Maxime Doublet, Céline Boucher, Matthieu Proust, Elsa Beard, T. Rosenberg, Lisa Durocher, Michèle Grosdenier, Luc-Philippe Christiaens, Stéphanie Ragot, Benjamin Khalifa
article en

Abstract

BACKGROUND: Transthyretin cardiac amyloidosis (ATTR-CM) is an underdiagnosed severe cardiomyopathy in older adults. Current diagnostic strategies rely on clinical "red flags", but data on systematic screening in minimally selected populations remain limited. We aimed to describe the prevalence of ATTR-CM among cardiology inpatients with left ventricular hypertrophy (LVH) and to identify parameters associated with its diagnosis. METHODS AND RESULTS: This prospective single-center study included consecutive patients aged ≥60 years hospitalized in cardiology with echocardiographic LVH (wall thickness ≥12 mm), irrespective of etiology. Patients with known amyloidosis, prior heart transplantation, or contraindication to scintigraphy were excluded. All patients underwent immunologic testing and technetium-99m scintigraphy. ATTR-CM was diagnosed by cardiac uptake (Perugini grade ≥2) without significant monoclonal gammopathy. Multivariable logistic regression identified independent associations and receiver-operating characteristic curve analysis assessed diagnostic performance. Between October 2021 and June 2023, ATTR-CM was diagnosed in 29 of 400 patients (7.3%). Four variables were independently associated with ATTR-CM: basal longitudinal strain (BLS) (odds ratio [OR] 0.84, 95% CI 0.74-0.95), non-sinus rhythm (OR 3.85, 95% CI 1.30-11.11), bilateral carpal tunnel syndrome (OR 3.48, 95% CI 1.09-11.14), and history of stroke (OR 8.67, 95% CI 2.65-28.34). BLS showed the highest discrimination for ATTR-CM (AUC 0.81). During a median follow-up of 3.31 years, all-cause mortality did not significantly differ between ATTR-CM and non-ATTR-CM patients (p=0.137). CONCLUSION: In a minimally selected cardiology population with LVH, systematic screening identified a substantial prevalence of ATTR-CM. BLS may help prioritize diagnostic testing in routine practice and facilitate earlier identification and management of ATTR-CM.

European Heart Journal - Cardiovascular Imaging
Inserm (FR), Université de Poitiers (FR), Sorbonne Université (FR), Assistance Publique – Hôpitaux de Paris (FR), Centre Hospitalier Universitaire de Poitiers (FR), Laboratoire Vision Action Cognition (FR), Fondation pour l’innovation en Cadiométabolisme et Nutrition (FR), Alliance nationale pour les sciences de la vie et de la santé (FR)
Peace, Justice and strong institutions
Openalex Percentile: Top 18%
Amyloidosis: Diagnosis, Treatment, Outcomes
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