{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:50Z","timestamp":1787028650454,"version":"build-2736575974"},"reference-count":12,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T00:00:00Z","timestamp":1729036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The early detection of transthyretin cardiac amyloidosis (ATTR-CM) is essential, with Tc-99m pyrophosphate scintigraphy (PYP scan) being a key diagnostic tool. Although a previously validated score has shown promise in predicting PYP scan positivity among patients with HFpEF, further evaluation in diverse cohorts is necessary. Objectives: To assess the effectiveness of the ATTR-CM score in predicting PYP scan positivity within our patient population. Methods: We analyzed patients referred for PYP with SPECT at the Cleveland Clinic from January 2012 to January 2020, all of whom had undergone echocardiography within the previous year. The ATTR-CM score was determined using the following criteria: Age (60\u201369, +2; 70\u201379, +3; \u226580, +4), sex (male, +2), hypertension (present, \u22121), left ventricular ejection fraction (LVEF &lt;60%, +1), posterior wall thickness (\u226512 mm, +1), and relative wall thickness (&gt;0.57, +2). A score of \u22656 indicated high risk. Results: Among the 540 patients (32% female, 33% black), 27% had an LVEF &lt;40%. The score demonstrated good discrimination by AUC, with consistent performance across different racial groups, sexes, and LVEF categories. For scores \u22656, sensitivity was lower in women and black patients; however, lowering the cutoff to 5 markedly improved sensitivity. Conclusions: The ATTR-CM score displayed consistently good performance by AUC across our cohort, including patients with HFrEF. Nevertheless, its sensitivity was reduced in black patients and women. Efforts to scale ATTR-CM diagnosis tools should be mindful of demographic differences in risk prediction models.<\/jats:p>","DOI":"10.3390\/jcm13206150","type":"journal-article","created":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T07:58:32Z","timestamp":1729065512000},"page":"6150","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Race, Sex, and Ejection Fraction-Based Differences in Transthyretin Amyloid Cardiomyopathy (ATTR-CM) Risk Prediction"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8587-2881","authenticated-orcid":false,"given":"Michel","family":"Chedid El Helou","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohak","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1533-6634","authenticated-orcid":false,"given":"Muzna","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazen","family":"Hanna","sequence":"additional","affiliation":[{"name":"Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Blumer","sequence":"additional","affiliation":[{"name":"Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preethi","family":"William","sequence":"additional","affiliation":[{"name":"Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milind Y.","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan Q.","family":"Abadie","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5671-9557","authenticated-orcid":false,"given":"Lauren","family":"Ives","sequence":"additional","affiliation":[{"name":"Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8335-735X","authenticated-orcid":false,"given":"W. H. Wilson","family":"Tang","sequence":"additional","affiliation":[{"name":"Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wael A.","family":"Jaber","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3941-9653","authenticated-orcid":false,"given":"Patrick","family":"Collier","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trejeeve","family":"Martyn","sequence":"additional","affiliation":[{"name":"Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2872","DOI":"10.1016\/j.jacc.2019.04.003","article-title":"Transthyretin Amyloid Cardiomyopathy: JACC State-of-the-Art Review","volume":"73","author":"Ruberg","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1001\/jamacardio.2021.3070","article-title":"Prevalence of Transthyretin Amyloid Cardiomyopathy in Heart Failure With Preserved Ejection Fraction","volume":"6","author":"AbouEzzeddine","year":"2021","journal-title":"JAMA Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1056\/NEJMoa1805689","article-title":"Tafamidis Treatment for Patients with Transthyretin Amyloid Cardiomyopathy","volume":"379","author":"Maurer","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"27","DOI":"10.14797\/mdcvj.1163","article-title":"Opportunities for Earlier Diagnosis and Treatment of Cardiac Amyloidosis","volume":"18","author":"Martyn","year":"2022","journal-title":"Methodist Bakey Cardiovasc. J."},{"key":"ref_5","first-page":"19","article-title":"The use of PYP scan for evaluation of ATTR cardiac amyloidosis at a tertiary medical centre","volume":"29","author":"Dower","year":"2022","journal-title":"Br. J. Cardiol."},{"key":"ref_6","unstructured":"American College of Cardiology (2023, July 06). Technetium Tc 99m PYP Scanning for TTR Cardiac Amyloidosis. Available online: https:\/\/www.acc.org\/Latest-in-Cardiology\/Journal-Scans\/2021\/06\/10\/16\/06\/http%3a%2f%2fwww.acc.org%2fLatest-in-Cardiology%2fJournal-Scans%2f2021%2f06%2f10%2f16%2f06%2fDiagnosing-Transthyretin-Cardiac."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1016\/j.cardfail.2022.06.005","article-title":"The Association of Cardiac Biomarkers, the Intensity of Tc99 Pyrophosphate Uptake, and Survival in Patients Evaluated for Transthyretin Cardiac Amyloidosis in the Early Therapeutics Era","volume":"28","author":"Martyn","year":"2022","journal-title":"J. Card. Fail."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1001\/jamacardio.2022.1781","article-title":"A Simple Score to Identify Increased Risk of Transthyretin Amyloid Cardiomyopathy in Heart Failure With Preserved Ejection Fraction","volume":"7","author":"Davies","year":"2022","journal-title":"JAMA Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.jchf.2022.06.006","article-title":"Racial and Genetic Differences in Presentation of Transthyretin Amyloid Cardiomyopathy With Impaired Left Ventricular Function","volume":"10","author":"Martyn","year":"2022","journal-title":"JACC Heart Fail."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2726","DOI":"10.1038\/s41467-021-22877-8","article-title":"Artificial intelligence-enabled fully automated detection of cardiac amyloidosis using electrocardiograms and echocardiograms","volume":"12","author":"Goto","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2768","DOI":"10.1016\/j.mayocp.2021.04.023","article-title":"Artificial Intelligence\u2013Enhanced Electrocardiogram for the Early Detection of Cardiac Amyloidosis","volume":"96","author":"Grogan","year":"2021","journal-title":"Mayo Clin. Proc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.1038\/s41467-021-22876-9","article-title":"A machine learning model for identifying patients at risk for wild-type transthyretin amyloid cardiomyopathy","volume":"12","author":"Huda","year":"2021","journal-title":"Nat. Commun."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/20\/6150\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:14:01Z","timestamp":1760112841000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/20\/6150"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,16]]},"references-count":12,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["jcm13206150"],"URL":"https:\/\/doi.org\/10.3390\/jcm13206150","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,16]]}}}