Grogan Staging System for Transthyretin Amyloid Cardiomyopathy (ATTR-CM)
Mayo Clinic three-stage staging for wild-type transthyretin cardiac amyloidosis using NT-proBNP and troponin T (derived in 360 patients). Complements the Gillmore system, which uses eGFR.
Score interpretation
Stage I: NT-proBNP and troponin T both below the cut-offs (4-year survival 57 %).
→ Initiate tafamidis 61 mg OD (adults) if not already started; monitor for disease progression (6-monthly NT-proBNP, hs-TnT, echo, 6MWT); genetic testing for TTR variants (V122I common in Black/African heritage; V30M common in Portuguese/Swedish/Japanese); family screening if hereditary ATTR; echocardiographic surveillance: septal thickness, diastolic function, longitudinal strain; avoid drug toxicity (see gillmore_attr_cm for medication cautions). Children: use a children's formulary.
Stage II: one of NT-proBNP or troponin T above the cut-off (4-year survival 42 %).
→ Disease-modifying therapy (tafamidis) essential; symptomatic management: diuretics for congestion, anticoagulation if AF (NOACs -- data limited in ATTR-CM, digoxin caution due to amyloid binding); 3-monthly biomarker monitoring; echocardiography 6-monthly; ICD if high-risk arrhythmia or EF <= 35%; pacemaker if conduction disease (common in ATTR-CM); advance care planning introduction; cardiomyopathy centre review.
Stage III: NT-proBNP and troponin T both above the cut-offs (4-year survival 18 %).
→ End-stage management as per Gillmore Stage III; palliative care involvement; advance care planning; tafamidis continuation (may slow progression even in stage III); heart transplantation at select centres (discussion warranted); symptom control: aggressive diuresis, nutritional support; DNACPR discussion; family support; spiritual care; referral to specialist amyloid service (National Amyloidosis Centre or equivalent).
Interpretation bands for the Grogan ATTR-CM Staging. Apply clinical judgement and local guidance.
References
- Grogan M, Scott CG, Kyle RA, et al. Natural History of Wild-Type Transthyretin Cardiac Amyloidosis and Risk Stratification Using a Novel Staging System. J Am Coll Cardiol. 2016;68(10):1014–1020.
- Maurer MS et al. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med. 2018;379(11):1007-1016.
Related
Curated clinical cross-links plus same-class fallbacks.
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.