**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Dr. Aparna Hari
Amrita Vishwa Vidyapeetham
Department of Cardiology
Kochi, Kerala
aparnahari018@gmail.com

**Main Body of the Abstract**
Background- The prognosis of patients with AL amyloidosis is largely determined by the extent of cardiac involvement. The Revised Mayo 2012 prognostic model relies on biomarkers of cardiac injury and abnormal clonal plasma cell proportions. ECG and Echo parameters reflecting the extent of cardiac involvement might provide additional prognostic information.

Methods- We aimed to develop an ECG-Echo staging for AL amyloidosis using the Amrita Amyloid Cohort, the largest of its kind from South Asia. Sparse Principal Component Analysis was used to select three linear combinations of the potential ECG and Echo predictors. A risk score was developed from these predictor combinations using a Cox proportion hazard model with restricted cubic spline terms. This model was subsequently approximated by a decision tree pruned so that its R2 score would be at least 90%.

Results- A total of 174 patients were included in the study with a median follow-up time of 7 months. The following three combinations of risk factors explain 85% of the variability: average of septal S’ and lateral S’, RWT/SaVR, and EF. The decision tree is shown in the figure with survival curves. A bootstrap estimate of the Somers D from the ECG-Echo stages was 37%, a slightly better performance than the Mayo stages of 35%.

Conclusion- The ECG-Echo risk score provides relevant information about cardiac involvement in AL amyloidosis patients. This staging system might augment the Mayo risk classification. Further validation in a larger cohort is required to evaluate the added value of this ECG-echo staging.



**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Dr. Aparna Hari
Amrita Vishwa Vidyapeetham
Department of Cardiology
Kochi, Kerala
aparnahari018@gmail.com

**Main Body of the Abstract**
**Background-** The prognosis of patients with AL amyloidosis is largely determined by the extent of cardiac involvement. The Revised Mayo 2012 prognostic model relies on biomarkers of cardiac injury and abnormal clonal plasma cell proportions. ECG and Echo parameters reflecting the extent of cardiac involvement might provide additional prognostic information.

**Methods-** We aimed to develop an ECG-Echo staging for AL amyloidosis using the Amrita Amyloid Cohort, the largest of its kind from South Asia. Sparse Principal Component Analysis was used to select three linear combinations of the potential ECG and Echo predictors. A risk score was developed from these predictor combinations using a Cox proportion hazard model with restricted cubic spline terms. This model was subsequently approximated by a decision tree pruned so that its R2 score would be at least 90%.

**Results-** A total of 174 patients were included in the study with a median follow-up time of 7 months. The following three combinations of risk factors explain 85% of the variability: average of septal S’ and lateral S’, RWT/SaVR, and EF. The decision tree is shown in the figure with survival curves. A bootstrap estimate of the Somers D from the ECG-Echo stages was 37%, a slightly better performance than the Mayo stages of 35%.

**Conclusion-** The ECG-Echo risk score provides relevant information about cardiac involvement in AL amyloidosis patients. This staging system might augment the Mayo risk classification. Further validation in a larger cohort is required to evaluate the added value of this ECG-echo staging.



An ECG-Echo Risk Score for Systemic Light Chain Amyloidosis OA12 (#267)

We invite you to attend the XIX International Symposium on Amyloidosis to be held in Rochester, MN.

This symposium is organized as a hybrid meeting (with the focus on in-person) held from Sunday, May 26 through Thursday, May 30, 2024.

Together with the ISA Board and members of Mayo Clinic, a very attractive scientific hybrid program is being planned. The program will cover a variety of types of systemic amyloidosis: ATTR (hereditary and wild-type), AL (light-chain), AA and less frequent forms. There will be key lectures, specific symposia including those company sponsored, oral presentations and poster sessions of accepted abstracts.

COURSE DESCRIPTION
This program will provide a comprehensive review of state-of-the-art education in systemic amyloidosis: basic science, pathophysiology, diagnosis, current and emerging treatments. Scientific presentations will include competitive oral and poster abstracts. The rapid evolution of scientific discovery and expanding treatment options has created tremendous interest in the field and this meeting will fill and important gap in educating scientists and clinicians.