SPC365

LA cardiomyopathy in ATTR-CM: the incremental prognostic value of LA strain

Session: Sessão de Comunicações Orais 11 – Corações espessos e rígidos: amiloidose cardíaca e companhia
Speaker: Miguel Sobral Domingues

Congress: CPC 2026
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Comunicações Orais
FP Number: ---
Authors: Miguel Sobral Domingues; André Garcia; Rita Carvalho; Tânia Laranjeira; Sérgio Maltês; Carlos Aguiar; Marisa Trabulo; Regina Ribeiras; Bruno M. Rocha

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,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"> Cardiac amyloidosis due to transthyretin deposition (ATTR-CM) may lead to progressive diastolic dysfunction, increased left ventricular (LV) filling pressures, and atrial mechanical impairment. Left atrial (LA) strain emerged as a sensitive marker of atrial function, often detecting dysfunction earlier than traditional volumetric parameters. However, the prognostic value of LA strain impairment for predicting adverse outcomes in ATTR-CM has not been fully elucidated.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Aim:</span></strong><span style="font-family:&quot;Times New Roman&quot;,serif"> To assess the prognostic value of LA strain in a cohort of patients with ATTR-CM.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,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"> We conducted a single-centre retrospective study of consecutive patients with symptomatic HF due to ATTR-CM followed from 2019-2025. Diagnosis was established according to the recommended algorithm. Echocardiographic data was collected from the first transthoracic echocardiogram (TTE) performed at our institution. LA strain analysis was performed according to the up-to-date EACVI/ASE recommendations. The primary endpoint was a composite of all-cause death or cardiovascular hospitalization at 3 years. Survival was assessed using&nbsp;Cox regression models. The best cut-off for LA strain-derived parameters was determined by ROC curve analysis.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,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"> A total of 286 ATTR-CM patients were identified, of whom 177 had an available baseline TTE and were included &ndash; median age 83 [78-87] years; 82% male; 72% on TTR stabilizers; 45% in AF; median LAVI 52 [43&ndash;63] mL/m2; median LA reservoir strain 6.5 [4.5&ndash;11] % and LA contractile strain 1 [0&ndash;4]%; median follow-up of 1.9 [1.0&ndash;3.0] years. The primary endpoint occurred in 64 patients (36%), of whom 48 died. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">In univariate analysis, LA reservoir, contractile and conduit strain, NYHA, left ventricular ejection fraction (LVEF), NT-proBNP, serum sodium, creatinine, and tafamidis therapy were significantly associated with the primary endpoint. LA volume was not associated with the primary outcome. In a multivariate model adjusted for NYHA, atrial fibrillation, LVEF, NT-proBNP, sodium, creatinine, and tafamidis, both LA reservoir strain (HR 0.92 per 1% increase; 95% CI 0.86&ndash;0.98; p=0.007) and LA contractile strain (HR 0.89 per 1% increase; 95% CI 0.82&ndash;0.97; p=0.007) remained independent predictors of death or cardiovascular&nbsp;hospitalization. A LA reservoir strain &lt;10% (n=118; 66%)&nbsp;and a LA contractile strain &lt;4% (n=123; 69%) independently predicted the primary endpoint (HR 2.34; 95% CI 1.17&ndash;4.67; p=0.016 <span style="color:black">and HR 2.17; 95% CI 1.09&ndash;4.35; p=0.029, </span>respectively).</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,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 a cohort of patients with ATTR-CM, LA reservoir and contractile strain added significant prognostic value beyond well-established clinical, biochemical, and echocardiographic markers. A LA reservoir strain &lt;10% and LA contractile strain &lt; 4% <span style="color:black">more than doubled </span>the risk of death or cardiovascular hospitalization, thus highlighting its value as meaningful independent markers for risk stratification.</span></span></span></p>