Recognizing a need to update the 2021 criteria for monitoring disease progression in patients with transthyretin amyloid cardiomyopathy (ATTR-CM), a group of international experts shared new proposed criteria, including recommendations for thresholds and monitoring frequency, in a recent Position Statement published in JACC: Heart Failure.

Pablo García-Pavía, MD, PhD, Matthew S. Maurer, MD, FACC, et al., introduce six parameters as part of the updated disease monitoring criteria, including heart failure-related hospitalization, outpatient diuretic intensification, NT-proBNP, estimated glomerular filtration rate, six-minute walk test and quality of life measured by the Kansas City Cardiomyopathy Questionnaire or NYHA functional class.

They suggest that disease progression can be considered if at least two of the parameters meet the defined thresholds outlined above. Although "there is evidence supporting the prognostic value of each parameter within the proposed criteria," they note that use of only one parameter may result in overestimating a patient's disease progression.

The criteria also encourage clinicians to evaluate these parameters every 12 months and to compare results with those from the previous 12 months, not measurements at baseline. "In addition, they should not be compared with values measured over the course of 12 months, to avoid using random fluctuations and oversampling to determine disease progression," note the authors.

García-Pavía and colleagues credit new data demonstrating the prognostic value of certain parameters in ATTR-CM as well as heightened awareness among cardiologists and advances in diagnostic methods as key developments spurring these proposed updates.

"Future studies should investigate whether changes in ATTR-CM disease-modifying treatment improve outcomes in patients demonstrating disease progression," write the authors.