Abstract
AIMS: The RAISE Score, encompassing five domains (Remodeling, Age, Injury, Systemic, Electrical), was proposed to screen for transthyretin amyloid cardiomyopathy (ATTR-CM) in patients with aortic stenosis (AS), but is not routinely used. This study evaluated its performance following aortic valve replacement (AVR). METHODS: This single-center, prospective, observational study included patients aged ≥ 60 years with end-diastolic interventricular septum thickness (IVSd) ≥ 12 mm, who underwent hydroxydiphosphonate (HDP) bone scintigraphy after AVR between March 2021 and July 2024. The diagnostic performance of the RAISE Score assessed at 30-day follow-up and of simpler screening parameters for pathological HDP uptake (Perugini 1-3) were analyzed, along with their association with all-cause mortality and heart failure (HF) hospitalization. RESULTS: Among 131 included patients (median age 81 years; 64% male) pathological HDP uptake was found in 21 (16%), and 11 (8.4%) were diagnosed with ATTR-CM. A RAISE Score ≥ 2 demonstrated 76% sensitivity and 56% specificity for pathological bone scintigraphy, while a Score ≥ 3 showed 62% sensitivity and 78% specificity. The parameters age ≥ 83 years and the combination of carpal tunnel syndrome (CTS) and/or N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥ 1,400 pg/mL performed similarly to the RAISE Score. Cardiac HDP uptake showed a strong trend toward HF hospitalization (HR [95%-CI]: 5.81 [0.93-36.20]; p = 0.060) and all-cause mortality (HR [95%-CI]: 3.27 [0.95-11.24]; p = 0.060). CTS and/or NT-proBNP ≥ 1,400 pg/mL was significantly associated with higher all-cause mortality (HR [95%-CI]: 3.92 [1.04-14.84]; p = 0.044), whereas the RAISE Score was not. CONCLUSION: After AVR, the complex RAISE Score showed lower sensitivity than originally reported, while simpler parameters demonstrated comparable predictive value for ATTR-CM screening. Advanced age, CTS history and elevated NT-proBNP levels seem most valuable for identifying candidates for bone scintigraphy.