Heart failure & cardiomyopathiesSecondary analysis
Left Atrial Structure and Function, Clinical Outcomes, and Efficacy of Vutrisiran in Transthyretin Amyloidosis With Cardiomyopathy
- Secondary analysis of the HELIOS-B randomised trial
- post hoc
- phase 3
- 87 sites in 26 countries
Authors' conclusion
Per the results of this secondary analysis of the HELIOS-B randomized clinical trial, LA dysfunction is common among patients with ATTR-CM and portends a worse prognosis.
Study context
- Population
- Patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM)644 with measurable left atrial (LA) strain
- Participants
- 655 patients
- Comparison
- Vutrisiran vs placebo; prognostic value of LA structure and function
- Primary endpoint
- All-cause mortality (ACM) and recurrent CV events
- Follow-up
- Median 36 (IQR 33-36) months
Primary result
As reported in the abstract
ACM and recurrent CV events, by LA strain
Hazard ratio (95% CI)P value
LASr (per 5% worsening)
1.37(1.13–1.68)
P = 0.002LASct (per 5% worsening)
1.53(1.08–2.17)
P = 0.02Per 5% worsening, as printed
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Recurrent HF hospitalizations, by LA strain — LASr vs Placebo | 1.66 (1.22–2.25) | P = 0.001 | |
| Recurrent HF hospitalizations, by LA strain — LASct vs Placebo | 2.23 (1.46–3.71) | P < 0.001 | |
| Incident AF, by LA strain — LASr vs Placebo | 1.30 (1.03–1.63) | P = 0.03 | |
| Incident AF, by LA strain — LASct vs Placebo | 2.02 (1.38–2.96) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | difference (95% CI) | P value |
|---|---|---|
| Change in LA strain · month 30 — Vutrisiran vs Placebo · LASr | +1.2% (+0.4% to +1.9%) | |
| Change in LA strain · month 30 — Vutrisiran vs Placebo · LAScd | +0.8% (+0.3% to +1.4%) | |
| Change in LA strain · month 30 — Vutrisiran vs Placebo · LASct | +0.8% (0% to +1.6%) |
Baseline LA strain (below normal)
- LASr, mean (SD)
- 9.5% [6.0%]
- LAScd, mean (SD)
- 6.9% [3.9%]
- LASct, mean (SD)
- 4.2% [4.0%]
Vutrisiran effect on all-cause mortality (ACM) and recurrent CV events by baseline LA strain
- LASr: no effect modification
- P for interaction = 0.60
- LAScd: no effect modification
- P for interaction = 0.58
- LASct: no effect modification
- P for interaction = 0.47
Original publication
Left Atrial Structure and Function, Clinical Outcomes, and Efficacy of Vutrisiran in Transthyretin Amyloidosis With Cardiomyopathy. JAMA Cardiol. Published 19 August 2026. doi:10.1001/jamacardio.2026.2992
Summarised from the published abstract; every number is checked against it