Incremental prognostic value of cardiac magnetic resonance beyond biomarker staging in transthyretin cardiac amyloidosis

Chiou, T; Minga, I; Subashchandran, V; Singulane, CC; Patel, AR; Zareba, KM; Lu, E; Goyal, A; Singh, J; Elliott, MD; Nadig, V; Fernandes, F; Vieira, ML; Fadl, S; Trankle, C; Shah, DJ; Gabr, EM; Poonawalla, M; Miralles, F; Sarswat, N; Pursnani, A; Patel, H; Addetia, K; Slivnick, J

doi:10.1093/ehjci/jeag170

Heart failure & cardiomyopathies

Incremental prognostic value of cardiac magnetic resonance beyond biomarker staging in transthyretin cardiac amyloidosis

Eur Heart J Cardiovasc ImagingPublished 1 Jul 2026retrospectively analyzed a multicentre cohort

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Authors' conclusion

CMR-derived ECV and LAVi were associated with incremental prognostic value in ATTR-CA beyond biomarker staging and may inform clinical risk stratification.

Study context

Population: ATTR-CA patients who underwent cardiac magnetic resonance (CMR) between 2007 and 2023ATTR-CA patients who underwent CMR
Participants: 266 patients

Exposure: CMR parameters incorporated into National Amyloidosis Centre (NAC) staging vs baseline model using NAC stage
Outcome: Death
Follow-up: Median 20 months (IQR 8-35)

Methodological detailsinternal validation via bootstrapping, decision curve analysis

Internal validation via bootstrapping
Decision curve analysis

Main finding

As reported in the abstract

Patients who died

85 patients

32%

Observational data: associations, not effects.

Further findings

Mortality, ECV ≥ 59% (after NAC adjustment)

	← Lower risk ←→ Higher risk →	HR (95% CI)	P value
ECV ≥ 59%Independently associated with mortality after NAC adjustment	0.20.5125	2.45 (1.2–5.2)	P = 0.020
	0.20.5125Hazard ratio (log scale)

Mortality, LAVi ≥ 54 mL/m² (after NAC adjustment)

	← Lower risk ←→ Higher risk →	HR (95% CI)	P value
LAVi ≥ 54 mL/m²Independently associated with mortality after NAC adjustment	0.20.5125	2.00 (1.1–3.7)	P = 0.026
	0.20.5125Hazard ratio (log scale)

Prognostic accuracy

ECV and LAVi improved prognostic accuracy across all biomarker stages

Decision curve analysis: identification of high-risk patients for advanced heart failure (HF) or emerging disease-modifying therapies

Additional high-risk patients identified per 1000 with CMR alongside NAC staging: 28

Original publication

Incremental prognostic value of cardiac magnetic resonance beyond biomarker staging in transthyretin cardiac amyloidosis. Eur Heart J Cardiovasc Imaging. Published 1 July 2026. doi:10.1093/ehjci/jeag170

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