Screening Strategies for Identification of Transthyretin Amyloid Cardiomyopathy (JACC Heart Failure May 2026)-Article: Screening Strategies for Identification of Transthyretin Amyloid Cardiomyopathy

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This study tested whether routine noncontrast chest CT scans can reveal structural heart and aortic features that improve cardiovascular risk prediction beyond standard clinical tools. Researchers used CT “radiomics” from the cardiac chambers and aorta, segmented with an open-source AI model, to build a risk score in the National Lung Screening Trial (NLST) and then validated it in 14,577 Mass General Brigham patients with no prior major cardiovascular events.<br /><br />The radiomics score predicted cardiovascular mortality and major adverse cardiac events (MACE: heart attack, stroke, or coronary revascularization) better than the PREVENT risk calculator and added value to coronary artery calcium (CAC) scoring. In external validation, the radiomics score had higher discrimination than PREVENT (C-index 0.66 vs 0.61) and improved prediction when combined with CAC (0.69 vs 0.66 for CAC alone). It also identified high-risk patients who were missed by PREVENT, including people with low or borderline clinical risk but elevated CT-based risk.<br /><br />Important predictive features included left ventricular volume and shape, left atrial dimensions, and aortic surface-to-volume ratio. The score was especially useful in patients missing clinical data needed to calculate PREVENT, which was common in real-world practice. In the guideline-eligible group, most patients lacked at least one PREVENT input, and the CT score still stratified risk well.<br /><br />The authors conclude that routine chest CT contains clinically useful cardiovascular information beyond current risk calculators and CAC. They suggest this could support opportunistic screening to identify patients who may benefit from more intensive prevention, though prospective trials are needed to confirm clinical utility.

Meta Tag

Concept Noncontrast Chest CT

Concept Radiomics

Concept Cardiovascular Risk Prediction

Concept Radiomics Score

Concept Risk Stratification

Keywords

routine chest CT

cardiovascular risk prediction

radiomics score

PREVENT calculator

coronary artery calcium

major adverse cardiac events

cardiovascular mortality

left ventricular volume

left atrial dimensions

aortic features

Noncontrast Chest CT

Radiomics

Cardiovascular Risk Prediction

Radiomics Score

Risk Stratification