# Grogan 2016 ATTRwt staging Grogan Status: LIVE Price: $0.005 USDC `GET /api/calc/grogan` HTML: https://magentlab.com/docs/grogan Markdown: https://magentlab.com/docs/grogan.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Apply the Grogan 2016 two-biomarker staging system for wild-type transthyretin (ATTRwt) cardiac amyloidosis from NT-proBNP and cardiac troponin T. ## When to use When an agent has caller-supplied NT-proBNP (ng/L) and cardiac troponin T (ng/mL) and needs the published Grogan 2016 ATTRwt stage. Not Gillmore 2018 NAC ATTR staging. Not Mayo AL amyloid staging. Not NYHA. magent does not assay the biomarkers and does not invent a troponin I cutoff. ## When not to use - Not a medical device. magent does not examine the patient and does not assay NT-proBNP or troponin T. - This is Grogan 2016 wild-type ATTR (ATTRwt) staging only. It is not Gillmore 2018 NAC ATTR staging (no eGFR). It is not Mayo AL amyloid staging. It is not NYHA class. - Troponin T only (cTnT > 0.05 ng/mL, same as 0.05 μg/L). magent does not invent a troponin I cutoff. - 4-year OS figures (stage I 57%, II 42%, III 18%) and stage III median survival 20 months are published Grogan 2016 cohort labels, not a patient-specific prediction. - Not a treatment order. This tool does not recommend tafamidis or any other therapy. ## Formula ``` Grogan = (nt_probnp_ng_l > 3000) + (troponin_t_ng_ml > 0.05); each 1; Grogan 2016 ATTRwt; stage I = 0, II = 1, III = 2; equal to a cutoff does not add a point ``` ## Citation [Natural History of Wild-Type Transthyretin Cardiac Amyloidosis and Risk Stratification Using a Novel Staging System](https://doi.org/10.1016/j.jacc.2016.06.033) Grogan M, Scott CG, Kyle RA, Zeldenrust SR, Gertz MA, Lin G, Klarich KW, Miller WL, Maleszewski JJ, Dispenzieri A J Am Coll Cardiol. 2016;68(10):1014-1020 DOI: [10.1016/j.jacc.2016.06.033](https://doi.org/10.1016/j.jacc.2016.06.033) ## Worked example ### NT-proBNP 1500 ng/L, troponin T 0.02 ng/mL Given: `nt_probnp_ng_l=1500, troponin_t_ng_ml=0.02` 1. NT-proBNP 1500 ng/L is not > 3000; troponin T 0.02 ng/mL is not > 0.05 2. score = 0; grogan_stage = I ### NT-proBNP 4000 ng/L, troponin T 0.08 ng/mL Given: `nt_probnp_ng_l=4000, troponin_t_ng_ml=0.08` 1. NT-proBNP 4000 ng/L is > 3000 (1) and troponin T 0.08 ng/mL is > 0.05 (1) 2. score = 2; grogan_stage = III ## Also searched as - Grogan staging - ATTRwt staging - wild-type transthyretin amyloidosis stage - Grogan 2016 - NT-proBNP troponin T ATTR - wild-type ATTR cardiac stage - ATTRwt-CM staging - cTnT NT-proBNP ATTR ## Parameters - `nt_probnp_ng_l` (number, required): NT-proBNP in ng/L (10-100000), same numeric value as pg/mL. Grogan 2016 scores 1 point when > 3000; equal to 3000 does not score. magent does not assay NT-proBNP. - `troponin_t_ng_ml` (number, required): Cardiac troponin T (cTnT) in ng/mL (0.001-50), same numeric value as 0.05 μg/L. Grogan 2016 scores 1 point when > 0.05; equal to 0.05 does not score. Troponin T only; magent does not invent a troponin I cutoff and does not assay troponin. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/grogan` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "nt_probnp_ng_l": "1500", "troponin_t_ng_ml": "0.02" }, { "nt_probnp_ng_l": "1500", "troponin_t_ng_ml": "0.02" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/grogan Example 200: ```json { "count": 2, "path": "/api/calc/grogan", "items": [ { "components": [ { "value": 1.5e3, "factor": "nt_probnp_gt_3000", "points": 0, "present": false }, { "value": 0.02, "factor": "troponin_t_gt_0_05", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Grogan M, Scott CG, Kyle RA, Zeldenrust SR, Gertz MA, Lin G, Klarich KW, Miller WL, Maleszewski JJ, Dispenzieri A", "doi": "10.1016/j.jacc.2016.06.033", "id": "grogan-2016", "pmid": "27585505", "source": "J Am Coll Cardiol. 2016;68(10):1014-1020", "title": "Natural History of Wild-Type Transthyretin Cardiac Amyloidosis and Risk Stratification Using a Novel Staging System" }, "formula": "grogan", "formula_expression": "Grogan = (nt_probnp_ng_l > 3000) + (troponin_t_ng_ml > 0.05); each 1; Grogan 2016 ATTRwt; stage I = 0, II = 1, III = 2; equal to a cutoff does not add a point", "max_score": 2, "score": 0, "nt_probnp_ng_l": 1.5e3, "grogan_stage": "I", "published_os_4_year_percent": 57, "troponin_t_ng_ml": 0.02 }, { "components": [ { "value": 1.5e3, "factor": "nt_probnp_gt_3000", "points": 0, "present": false }, { "value": 0.02, "factor": "troponin_t_gt_0_05", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Grogan M, Scott CG, Kyle RA, Zeldenrust SR, Gertz MA, Lin G, Klarich KW, Miller WL, Maleszewski JJ, Dispenzieri A", "doi": "10.1016/j.jacc.2016.06.033", "id": "grogan-2016", "pmid": "27585505", "source": "J Am Coll Cardiol. 2016;68(10):1014-1020", "title": "Natural History of Wild-Type Transthyretin Cardiac Amyloidosis and Risk Stratification Using a Novel Staging System" }, "formula": "grogan", "formula_expression": "Grogan = (nt_probnp_ng_l > 3000) + (troponin_t_ng_ml > 0.05); each 1; Grogan 2016 ATTRwt; stage I = 0, II = 1, III = 2; equal to a cutoff does not add a point", "max_score": 2, "score": 0, "nt_probnp_ng_l": 1.5e3, "grogan_stage": "I", "published_os_4_year_percent": 57, "troponin_t_ng_ml": 0.02 } ] } ``` ## Response fields - `formula` (string): grogan - `formula_expression` (string): Exact Grogan 2016 ATTRwt expression used - `nt_probnp_ng_l` (number): NT-proBNP used in ng/L (same numeric value as pg/mL) - `troponin_t_ng_ml` (number): Cardiac troponin T used in ng/mL (same numeric value as μg/L) - `score` (integer): Grogan 2016 points 0-2 - `max_score` (integer): 2 - `grogan_stage` (string): I (0 points), II (1 point), or III (2 points). Grogan 2016 ATTRwt. Not Gillmore 2018 NAC. Not Mayo AL amyloid staging. - `published_os_4_year_percent` (integer): Published Grogan 2016 cohort 4-year overall survival percent for this stage (I 57, II 42, III 18). A cohort label, not a patient-specific prediction. Stage III median survival 20 months is published in the paper and is not returned as a prediction. - `components` (array): Per-factor points - `citation` (object): Grogan 2016 J Am Coll Cardiol citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "value": 1.5e3, "factor": "nt_probnp_gt_3000", "points": 0, "present": false }, { "value": 0.02, "factor": "troponin_t_gt_0_05", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Grogan M, Scott CG, Kyle RA, Zeldenrust SR, Gertz MA, Lin G, Klarich KW, Miller WL, Maleszewski JJ, Dispenzieri A", "doi": "10.1016/j.jacc.2016.06.033", "id": "grogan-2016", "pmid": "27585505", "source": "J Am Coll Cardiol. 2016;68(10):1014-1020", "title": "Natural History of Wild-Type Transthyretin Cardiac Amyloidosis and Risk Stratification Using a Novel Staging System" }, "formula": "grogan", "formula_expression": "Grogan = (nt_probnp_ng_l > 3000) + (troponin_t_ng_ml > 0.05); each 1; Grogan 2016 ATTRwt; stage I = 0, II = 1, III = 2; equal to a cutoff does not add a point", "max_score": 2, "score": 0, "nt_probnp_ng_l": 1.5e3, "grogan_stage": "I", "published_os_4_year_percent": 57, "troponin_t_ng_ml": 0.02 } ``` ## Errors - HTTP 400 `invalid_nt_probnp`: nt_probnp_ng_l must be a number from 10 to 100000 (NT-proBNP ng/L = pg/mL; Gillmore 2018 NAC ATTR stage). Returned before settlement; you are not charged. - HTTP 400 `invalid_troponin_t`: troponin_t_ng_ml must be a number from 0.001 to 50 (cTnT ng/mL). Returned before settlement; you are not charged. - HTTP 400 `invalid_grogan`: Grogan ATTR-CM staging needs nt_probnp_ng_l and troponin_t_ng_ml (Grogan 2016). Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [Gillmore](https://magentlab.com/docs/gillmore) — Apply the Gillmore 2018 National Amyloidosis Centre (NAC) three-stage system for cardiac transthyretin amyloidosis from NT-proBNP and caller-assigned eGFR. - [MAGGIC](https://magentlab.com/docs/maggic) — Sum the Pocock 2013 MAGGIC integer chart from thirteen caller-supplied heart-failure predictors and return the published Table 4 1-year and 3-year death probabilities for scores 0-50. - [NYHA](https://magentlab.com/docs/nyha) — Return the 1994 NYHA functional capacity class 1-4 from a caller-assigned integer, with the published class description. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.