In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
Abstract:
Background: A high prevalence of cardiac amyloidosis (CA) can be found in specific populations such as TAVI [transcatheter aortic valve implantation] referrals. However, CA diagnosis is complex and often missed. Several institutions have engaged active chart review by a multidisciplinary clinical committee (MCC) - a highly labor intensive process - to identify patients at risk for CA. Objective: To assess whether the recently published RAISE score (Remodeling, Age, cardiac Injury, Systemic and Electrical abnormalities) could be a substitute to optimize the MCC based pre-screening process in a TAVI population. Methods: Our institutional MCC reviewed the medical chart of all patients who underwent TAVI in the past 3 years and appreciated the utility of scintigraphic screening. The decision to screen or not was based on the presence of red flags and the anticipated clinical benefice. The original RAISE score was slightly modified (mRAISE, Figure ) to facilitate its use in our TAVI patients, for whom CA suspicion had never been raised. A patient with a score ≥3 was considered at high risk for CA (best cutoff previously published). The mRAISE score was compared to the MCC’s decision using a Cohen’s k. Results: Among 239 included patients (79±7y, 55% male), an mRAISE score ≥3 was found in 47 (20%), of whom the MCC suggested screening to only 25 (53% agreement), most of the remaining 22 being asymptomatic following TAVI. Of 192 patients (79%) with an mRAISE score 〈 3, the MDC decided on “no screening” for 180 (94% agreement) and “screening” for the other 12; 3 patients refused and 9 had a negative screening. When compared with the MCC’s decision, global agreement of the mRAISE score was 86% with k=0.52 ( Figure ). Conclusions: The mRAISE score is not a perfect substitute for a MCC but rather an ideal pre-screening tool to optimize efficiency. If calculated prior to MCC meetings, an mRAISE score 〈 3 can dramatically reduce the number of medical charts that need extensive review ( 〉 3/4 in our cohort).
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.146.suppl_1.13213
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2022
detail.hit.zdb_id:
1466401-X
