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Gillmore Staging System for Transthyretin Amyloid Cardiomyopathy (ATTR-CM)

Two-biomarker prognostic stage for ATTR cardiac amyloidosis (wild-type or hereditary).

Gillmore Staging System for Transthyretin Amyloid Cardiomyopathy (ATTR-CM)
NT-proBNP
ng/L
eGFR
mL/min/1.73m2
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When to use

  • Prognostic staging of confirmed ATTR cardiac amyloidosis (wild-type or hereditary) at diagnosis or before starting disease-modifying therapy.

Formula

Stage I: NT-proBNP <=3000 ng/L and eGFR >=45 mL/min. Stage III: NT-proBNP >3000 ng/L and eGFR <45 mL/min. Stage II: either value abnormal but not both.

Pearls and pitfalls

  • Validated in both ATTRwt and hereditary ATTRv cardiomyopathy, and externally validated in a French cohort.
  • Simpler than the Grogan (Mayo) system, which uses troponin T and NT-proBNP instead of renal function.

References

  1. Gillmore JD, Damy T, Fontana M, et al. Eur Heart J. 2018;39(30):2799-2806.