Heart failure & cardiomyopathies
Diagnostic and Prognostic Value of the Left Atrial Myopathy Evaluation in Cardiac Amyloidosis Using Echocardiography
Authors' conclusion
Characterizing LA myopathy has significant diagnostic and prognostic utility in CA. ATTR patients have increased atrial dyssynchrony, which may have implications for AF development. LA reservoir strain was associated with heart failure in CA, whilst LA minimum volume was a predictor of mortality in AL CA.
Study context
- Population
- Patients with ATTR or AL cardiac amyloidosis vs hypertensive heart disease, assessed by transthoracic echocardiography incl. Left atrial (LA) strain and LA mechanical dispersion
- Participants
- 86 / 86 / 58
- Exposure
- ATTR cardiac amyloidosis (CA) vs AL CA vs hypertensive heart disease
- ATTRn = 86
- ALn = 86
- HHTn = 58reference
- Outcome
- LA mechanical dispersion (LA-MD)
Main finding
As reported in the abstract
ATTR
72.2
median · IQR 55–88.9
AL
54
median · IQR 43.5–64.2
P < 0.001
- LA mechanical dispersion (LA-MD) independent determinant of ATTR CA (multivariable logistic regression adjusted for age, atrial fibrillation (AF), left ventricular (LV) mass, global and basal strain, E/e')
- P = 0.014
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | P value | |
|---|---|---|---|
| Mortality in AL CA (LA minimum volume, cut-off ≥18 mL/m²) · median follow-up 66 monthsALvs HHTCox; LA minimum volume; Kaplan-Meier P = 0.016 | 1.042 (1.003–1.082) | P = 0.034 | |
| 0.512Hazard ratio (log scale) |
- Mortality in AL CA (LA minimum volume, cut-off ≥18 mL/m²): 26 mortality events (ATTR and AL)
LV mass, diastolic function, LV GLS, LA volume and function
- More impaired in ATTR vs AL; more impaired in both amyloid groups vs HHT
- P < 0.05
Heart failure in CA (LA reservoir strain)
- LA reservoir strain independently associated with HF in CA (multivariable)
- P < 0.001
Original publication
Diagnostic and Prognostic Value of the Left Atrial Myopathy Evaluation in Cardiac Amyloidosis Using Echocardiography. ESC Heart Fail. Published 11 August 2024. doi:10.
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