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Purpose <p>To evaluate temporal trends in diagnostic testing for cardiac transthyretin amyloidosis (ATTR-CM) across U.S. health systems in the contemporary era.</p> Methods <p>We conducted a retrospective, descriptive analysis using the TriNetX U.S. Collaborative Network, identifying patients diagnosed with wild-type or hereditary ATTR-CM between January 2017 and November 2025. ATTR-specific ICD-10 codes were combined with evidence of cardiac involvement, and patients with light-chain amyloidosis or plasma cell dyscrasias were excluded. Diagnostic testing, including technetium-99m (Tc-99m) bone scintigraphy, cardiac magnetic resonance imaging (CMR), and biopsy, was assessed within an extended diagnostic ascertainment window spanning 24 months before and 12 months after diagnosis.</p> Results <p>The number of patients diagnosed with ATTR-CM increased markedly over time. Use of Tc-99m scintigraphy and CMR rose substantially in absolute terms, while biopsy utilization declined steadily. Dual-modality imaging increased modestly, and invasive histologic confirmation became progressively less common, indicating a shift toward imaging-based diagnosis.</p> Conclusion <p>Between 2017 and 2025, diagnostic evaluation of ATTR-CM shifted decisively toward noninvasive imaging, with declining reliance on biopsy. Although imaging volume increased, proportional adoption did not keep pace with expanding case identification, underscoring the need for broader implementation of guideline-recommended diagnostic pathways.</p>

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Temporal shifts in diagnostic testing for cardiac amyloidosis across U.S. health systems

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年8月3日

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  • Issam Motairek,
  • Bryan Abadie,
  • Andrew Higgins,
  • Zain N. Jawad,
  • Pavan Bhat,
  • Andres Carmona Rubio,
  • Mazen Hanna,
  • Wael A. Jaber

摘要

Purpose

To evaluate temporal trends in diagnostic testing for cardiac transthyretin amyloidosis (ATTR-CM) across U.S. health systems in the contemporary era.

Methods

We conducted a retrospective, descriptive analysis using the TriNetX U.S. Collaborative Network, identifying patients diagnosed with wild-type or hereditary ATTR-CM between January 2017 and November 2025. ATTR-specific ICD-10 codes were combined with evidence of cardiac involvement, and patients with light-chain amyloidosis or plasma cell dyscrasias were excluded. Diagnostic testing, including technetium-99m (Tc-99m) bone scintigraphy, cardiac magnetic resonance imaging (CMR), and biopsy, was assessed within an extended diagnostic ascertainment window spanning 24 months before and 12 months after diagnosis.

Results

The number of patients diagnosed with ATTR-CM increased markedly over time. Use of Tc-99m scintigraphy and CMR rose substantially in absolute terms, while biopsy utilization declined steadily. Dual-modality imaging increased modestly, and invasive histologic confirmation became progressively less common, indicating a shift toward imaging-based diagnosis.

Conclusion

Between 2017 and 2025, diagnostic evaluation of ATTR-CM shifted decisively toward noninvasive imaging, with declining reliance on biopsy. Although imaging volume increased, proportional adoption did not keep pace with expanding case identification, underscoring the need for broader implementation of guideline-recommended diagnostic pathways.