Atrial Mechanical Contraction Predicts Cerebrovascular Risk in Patients With Transthyretin Amyloid Cardiomyopathy and Sinus Rhythm

Porcari, A; Passo, BD; Venneri, L; Aimo, A; Sezer, ZI; Bandera, F; Razvi, Y; Sheikh, A; Mansell, J; Rauf, MU; Zaro, E; Giampieri, G; Burgel, C; De Caterina, R; Emdin, M; Petrie, A; Knight, DS; Virsinskaite, R; Kotecha, T; Wechalekar, A; Lachmann, H; Whelan, C; Moody, WE; Martinez-Naharro, A; Jering, KS; Solomon, SD; Hawkins, PN; Gillmore, JD; Fontana, M

doi:10.1016/j.jacc.2025.12.033

Heart failure & cardiomyopathies

Atrial Mechanical Contraction Predicts Cerebrovascular Risk in Patients With Transthyretin Amyloid Cardiomyopathy and Sinus Rhythm

J Am Coll CardiolPublished 18 Feb 2026Retrospective cohort study

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Authors' conclusion

LA dysfunction, particularly AEMD and severely impaired LASc, is associated with increased cerebrovascular events in ATTR-CM.

Study context

Population: Patients with ATTR-CM in sinus rhythm not receiving anticoagulation, UK National Amyloidosis Centre, 2003–2023873 in sinus rhythm (SR) without anticoagulation
Participants: 2,310 patients

Exposure: Atrial electromechanical dissociation (AEMD) vs SR with left atrial (LA) mechanical contraction; Left atrial strain contraction (LASc) tertiles
AEMDn = 115
Outcome: Cerebrovascular event (stroke or TIA, whichever first); death as competing event

Methodological detailssingle-centre

Single-centre

Main finding

As reported in the abstract

Stroke or TIA · median 34 months

Group	Stroke or transient ischemic attack (TIA)
AEMD	8.7 per 100 person-years
SR with LA mechanical contraction	2.5 per 100 person-years

Stroke or transient ischemic attack (TIA)

AEMD8.7 per 100 person-years

SR with LA mechanical contraction2.5 per 100 person-years

Stroke/TIA in SR patients: 85 (9.7%)

Observational data: associations, not effects.

Secondary outcomes

Incident atrial fibrillation (AF)

Incident AF in SR patients: 269 (30.8%)
AEMD: 2.4-fold higher incident AF vs SR with LA mechanical contraction

1-year stroke or TIA by LASc tertile (SR without AEMD, n = 758)

LASc <4% vs LASc >7%: 10-fold increased risk
Consistent after adjustment for NAC stage and prior cerebrovascular events
Adding LASc tertiles to CHA2DS2-VASc or CHA2DS2-VA significantly improved model fit and risk reclassification at 1 year

Stroke or TIA in baseline AF receiving anticoagulation

Rate: 0.7 per 100 person-years

Reference

Authors: Porcari A, Passo BD, Venneri L, Aimo A, Sezer ZI, Bandera F, et al.
All 29 authors
Porcari A, Passo BD, Venneri L, Aimo A, Sezer ZI, Bandera F, Razvi Y, Sheikh A, Mansell J, Rauf MU, Zaro E, Giampieri G, Burgel C, De Caterina R, Emdin M, Petrie A, Knight DS, Virsinskaite R, Kotecha T, Wechalekar A, Lachmann H, Whelan C, Moody WE, Martinez-Naharro A, Jering KS, Solomon SD, Hawkins PN, Gillmore JD, Fontana M
Journal: JACC
Published: 18 Feb 2026
DOI: 10.1016/j.jacc.2025.12.033
PubMed: 41706061

Topic: Heart failure & cardiomyopathies
Also indexed: Arrhythmias & electrophysiology

Exposure definitions

AEMD: SR on ECG with absent left atrial strain contraction (LASc)

Key notes

AEMD: 3-fold higher risk of stroke or TIA vs SR with LA mechanical contraction, independent of CHA2DS2-based scores and disease severity markers

Original publication

Atrial Mechanical Contraction Predicts Cerebrovascular Risk in Patients With Transthyretin Amyloid Cardiomyopathy and Sinus Rhythm. J Am Coll Cardiol. Published 18 February 2026. doi:10.1016/j.jacc.2025.12.033

Read the original article ↗

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