Heart Failure
Screening Strategies for Transthyretin Amyloid Cardiomyopathy — State-of-the-Art Review
- Authors: Anthony E. Peters, Parag Goyal, et al.
- Journal / date: JACC: Heart Failure, May 2026 (Vol 14, No 5)
- DOI / URL: 10.1016/j.jchf.2026.103018 | PMID 41893375
- Source basis: Full text (JACC login)
- Study type: State-of-the-art review
- Scope: Synthesizes published ATTR-CM risk prediction models, identifies evidence gaps, and proposes opportunistic health-system screening strategies
- Key clinical points:
- ATTR-CM is substantially underdiagnosed relative to population estimates in at-risk groups (older adults with HFpEF, hereditary risk).
- Existing risk-prediction models can identify high-pretest-probability patients but lack prospective validation and broad health-system implementation.
- Opportunistic screening strategies include EHR-triggered alerts (LVH + low-flow gradient, carpal tunnel + HF, etc.), echo-derived flags, and structured family-history workflows.
- Why it matters (clinical takeaway):
- As disease-modifying therapies (tafamidis, acoramidis, vutrisiran) expand, identifying ATTR-CM early genuinely changes prognosis.
- Use the review's screening triggers in routine HFpEF and unexplained LVH practice — older man with HFpEF + carpal tunnel + LVH + low-voltage ECG should get PYP imaging + monoclonal screen.
- Health-system EHR triggers are the highest-yield organizational strategy — worth advocating at institutional level.
- Caveats / limitations: Review (not new evidence). Prospective validation of any specific screening pathway still needed.
- Referenced trials pulled forward: ATTR-ACT (tafamidis), ATTRibute-CM (acoramidis) — to add to trials/ on next pass.