Tuesday, 4 November 2025

Pérez A, Llàcer P, Salamanca P, Camafort M, García M, Ruiz R, Suárez A, Pérez C, Bravo I, Ruiz R, Aldea A, López G, Fernández C, Orduña MDP, Fabregate M, Aramburu O, Manzano L. Impact of a Checklist-Based Strategy for Cardiac Amyloidosis Screening on Diagnosis Rates in Heart Failure Patients (CHECKAMIC Study)

Eur J Intern Med. 2025

"Systematic use of a checklist-based screening strategy in HF patients resulted in a tenfold increase in the diagnosis of ATTR-CM". - Dr. Alberto Pérez Nieva & Dr. Pau Llàcer Iborra

Summary:

Background: Transthyretin-associated cardiac amyloidosis (ATTR-CM) is an underdiagnosed cause of heart failure (HF), particularly in elderly patients. Delayed diagnosis limits access to emerging disease-modifying therapies. We aimed to evaluate the impact of implementing a checklist-based screening strategy for ATTR-CM in specialized HF units.

Methods: We conducted a prospective, multicenter, observational study in three Spanish tertiary hospitals, enrolling patients ≥65 years old with HF and a positive checklist based on ESC red-flag criteria. All underwent a structured diagnostic workup for ATTR-CM. A retrospective control cohort from the same centers was used for comparison. The primary outcome was ATTR-CM diagnosis rate. Secondary analyses included identification of independent predictors of ATTR-CM and clinical outcomes at 6 months.

Results: Of 102 patients in the prospective cohort, 22 (21.6 %) were diagnosed with ATTR-CM, compared to only 2 of 110 patients (1.8 %) in the retrospective cohort (p < 0.001). The strongest independent predictor of ATTR-CM was a low QRS-to-mass ratio (OR 41.02; 95 % CI: 1.92-875.25; p = 0.017), followed by increased septal thickness, older age, higher left ventricular mass index, and lower body mass index. At 6-month follow-up, clinical outcomes were similar between patients with and without ATTR-CM.

Conclusions: In this prospective multicenter study of elderly HF patients, implementing a diagnostic checklist increased ATTR-CM detection tenfold compared to historical controls. A low QRS-to-mass ratio emerged as the strongest independent predictor. Checklist-based screening is a feasible strategy to improve early diagnosis of this underrecognized condition.

Why do you highlight this publication?

This is the first study to evaluate the impact of the 2021 ESC position statement on cardiac amyloidosis (CA) diagnosis, showing improved detection rates after implementing a dedicated screening checklist. Systematic use of a checklist-based screening strategy in heart failure units resulted in a tenfold increase in the diagnosis rate of ATTR-CM compared to historical controls. A low QRS-to-mass ratio emerged as the strongest predictor of transthyretin cardiac amyloidosis (ATTR-CM). These findings demonstrate the feasibility and effectiveness of a non-invasive diagnostic approach in this population.