An echocardiographic nomogram for the identification of cardiac amyloidosis in patients with left ventricular hypertrophy

Abstract Background Echocardiography is the principal non-invasive imaging modality for screening cardiac amyloidosis (CA). Purpose This study aimed to establish a cohort of CA-associated left ventricular hypertrophy (CA-LVH) within a hospital-based population and to develop an echocardiographic identification model for CA using readily available echocardiographic parameters. Methods This retrospective nested cohort study involved the collection of clinical and echocardiographic data of CA-LVH and non-CA-LVH cases from three hospitals between January 1, 2008, and December 31, 2023. Information collected from both groups encompassed basic data (age, gender, height, weight, history of hypertension), echocardiographic parameters (including various measurements related to ventricular dimensions, volumes, and functions), and echocardiographic characteristics (such as asymmetric hypertrophy, myocardial echo, pericardial effusion, and valvular regurgitation). Results A total of 185 CA patients who underwent 309 echocardiography examinations with 1,213 echocardiographic data points from non-CA-LVH cases matched for age, gender, and body surface area were included. Multivariable logistic regression analysis identified a history of hypertension [odds ratio (OR): 0.04, 95% confidence interval (CI): 0.021-0.073], left ventricular internal diameter in diastole (LVID) [OR: 0.927, 95%CI: 0.878-0.977], left ventricular ejection fraction (LVEF) [OR: 0.95, 95%CI: 0.908-0.993], AMYLI score [OR: 1.088, 95%CI: 1.024-1.161], asymmetric hypertrophy [OR: 3.729, 95%CI: 1.884-7.441], granular sparkling [OR: 3.111, 95%CI: 1.355-7.431], mild pericardial effusion [OR: 2.77, 95%CI: 1.563-4.937], mild aortic regurgitation [OR: 2.353, 95%CI: 1.278-4.361], mild mitral regurgitation [OR: 4.331, 95%CI: 2.347-8.141], and mild tricuspid regurgitation [OR: 3.837, 95%CI: 2.026-7.358] as independent predictive factors for CA in LVH patients. Finally, the constructed nomogram model demonstrated high accuracy (0.91-0.92), specificity (0.91-0.92), sensitivity (0.90-0.91), positive predictive value (0.73), negative predictive value (0.93-0.98), and Youden index (0.81-0.83). Conclusions The developed nomogram displayed remarkable predictive accuracy, which has the potential to enhance CA screening via routine echocardiography and strategically guide subsequent diagnostic evaluations.Graphic AbstractExample