Heart failure & cardiomyopathiesCohort study
Prognostic impact of chronotropic incompetence in transthyretin cardiac amyloidosis: a multicentre study
- multicentre retrospective study
Authors' conclusion
A blunted chronotropic response is common in transthyretin amyloid cardiomyopathy and conveys adverse short-term prognosis. A pHR% ≤75% represents a clinically meaningful and easily obtainable threshold for functional and prognostic stratification, offering a pragmatic alternative when comprehensive cardiopulmonary exercise testing assessment is not available.
Study context
- Population
- Stable outpatients with transthyretin amyloid cardiomyopathy, in sinus rhythm and naïve to disease-specific therapy, who underwent maximal cardiopulmonary exercise testingstable outpatients with transthyretin amyloid cardiomyopathy
- Participants
- 212 outpatients
- Exposure
- Chronotropic response and 1-year cardiovascular mortality
Main finding
As reported in the abstract
Prevalence of chronotropic incompetence (pHR% ≤75%)
Chronotropic incompetence defined by a pHR% ≤75% present
35%
Observational data: associations, not effects.
Further findings
| Outcome | hazard ratio | P value |
|---|---|---|
| Cardiovascular mortality per 1% increase in pHR% · 1 year | 0.945 | P = 0.011 |
- Cardiovascular mortality per 1% increase in pHR%: 5.5% relative reduction in cardiovascular mortality risk per 1% increase
Cardiovascular deaths · 1-year follow-up
- Cardiovascular deaths
- 10
Discrimination of pHR% threshold of 75%
- area under the curve
- 0.71
- Subgroup with significantly lower survival, log-rank
- P < 0.05
Original publication
Prognostic impact of chronotropic incompetence in transthyretin cardiac amyloidosis: a multicentre study. ESC Heart Fail. Published 3 July 2026. doi:10.1093/eschf/xvag170
Summarised from the published abstract; every number is checked against it