SPC365

Prognostic value of right ventricular systolic function markers in ATTR-CM

Session: Sessão de Comunicações Orais 10 – Estratificação de risco guiada por imagem em situações cardíacas complexas
Speaker: Andre Moniz Garcia

Congress: CPC 2026
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Comunicações Orais
FP Number: ---
Authors: André Moniz Garcia; Miguel Domingues; Rita Carvalho; Sergio Maltês; Tânia Laranjeira; Carlos Aguiar; Marisa Trabulo4; Regina Ribeiras; Bruno M. Rocha

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction:</span></strong><span style="font-family:&quot;Times New Roman&quot;,serif"> Left ventricular (LV) dysfunction is a well-established prognostic factor in transthyretin cardiac amyloidosis (ATTR-CM). Amyloid deposition in ATTR-CM often leads to biventricular thickening and dysfunction, which may reflect amyloid burden. The clinical significance of right ventricular (RV) function, however, is not clearly defined. </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Aims:</span></strong><span style="font-family:&quot;Times New Roman&quot;,serif"> To evaluate the added prognostic value of RV function in ATTR-CM.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Methods: </span></strong><span style="font-family:&quot;Times New Roman&quot;,serif">Single-centre retrospective study including all consecutive patients with heart failure (HF) due to ATTR-CM followed from 2019 to 2025. ATTR-CM was diagnosed as per the recommended multi-step algorithm. Echocardiographic parameters were obtained from the first available transthoracic echocardiogram (TTE) performed at our institution. We proceeded with RV function analysis as per the EACVI/ASE recommendations. Fractional area change (FAC), was obtained in 2D ecochardiogram and easily executed.&nbsp;The primary endpoint was all-cause death. Survival analysis was performed using univariate and multivariate Cox regression models. </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></strong><span style="font-family:&quot;Times New Roman&quot;,serif"> Among 286 patients with ATTR-CM, 214 were identified to have a baseline TTE with RV-measurable functional data (mean age 85 &plusmn; 6 years, 81% male, 71% tafamidis). RV assessment showed a mean FAC&nbsp;of 34.6 &plusmn; 9.4% and free wall longitudinal strain (RV-FWLS) of -17.0 &plusmn; 5.2%. Median tricuspid annular plane systolic excursion (TAPSE) was 17 (13-19) mm and mean RV S&rsquo; (RVS) wave was 10 (8-13) cm/s. Among markers of RV systolic function, univariate analysis showed that FAC and FWLS were the only RV-related independent predictors. </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">After a median follow-up of 1.8 (1.0&ndash;2.9) years, the primary endpoint was reached in 62 patients <u><span style="color:#65b4b4">(</span></u>29.0%). In multivariate analysis &ndash; adjusted for NYHA, LV ejection fraction, NT-proBNP, creatinine, RV-FWLS and tafamidis&ndash; FAC remained as an independent predictor of all-cause mortality, while RV-FWLS did not. ROC curve analysis showed the optimal cut-off value for FAC &lt;31% (present in 67% of the patients),<u><span style="color:#65b4b4"> </span></u>with an area under the curve (AUC) of 0.729 (sensitivity 59% , specificity 81%). In a new multivariate model adjusted for the same variables<u><span style="color:#65b4b4">,</span></u> FAC &lt;31% independently predicted the primary outcome with an HR 2.08 (95% CI 1.02-4.35; p=0.027). </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></strong><span style="font-family:&quot;Times New Roman&quot;,serif">: In this ATTR-CM cohort, FAC provided independent prognostic information beyond well-established clinical, biomarkers, and echocardiographic parameters. A FAC &lt; 31% was associated with a substantially higher risk of death &mdash; more than doubling the risk &mdash; highlighting its potential value for risk stratification.</span></span></span></p>