Heart failure & cardiomyopathiesCohort study
Atrial Mechanical Contraction Predicts Cerebrovascular Risk in Patients With Transthyretin Amyloid Cardiomyopathy and Sinus Rhythm
- Retrospective cohort study
- single-centre
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
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/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
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
Summarised from the published abstract; every number is checked against it