A Hemodynamic Echocardiographic Approach to Disease Severity and Prognosis in Transthyretin Amyloid Cardiomyopathy
Year: 2026
Type: article
Abstract: Background Transthyretin amyloid cardiomyopathy (ATTR-CM) causes heart failure and poor outcomes. Prognostic stratification is fundamental, yet validated staging systems rely exclusively on biomarkers, neglecting structural and functional cardiac parameters. Objectives This study evaluates a noninvasive hemodynamic echocardiographic approach to stratify patients with ATTR-CM. Methods Patients were categorized into 3 groups based on stroke volume index (SVi) and systolic pulmonary artery pressure (sPAP), markers of forward flow and elevated filling pressures. We compared receiver operating characteristic curves for various potentially predictive hemodynamic parameters to identify these as the most robust candidates for risk stratification. Optimal cutoffs (30 mL/m for SVi and 40 mm Hg for sPAP) were determined using the Liu index, supported by both univariable and multivariable survival analyses. The primary endpoint was the composite of all-cause mortality and heart failure hospitalization. Prognostic utility was evaluated using multivariable Cox regression, adjusted for age, sex, and disease-modifying therapy. Results The cohort included 293 patients with ATTR-CM: group 1 (normal SVi/sPAP, n = 115 [39%]), group 2 (low SVi or high sPAP, n = 129), and group 3 (low SVi/high sPAP, n = 49). The primary outcome occurred in 108 (37%) patients. The multivariable analysis confirmed the staging system as an independent predictor of the composite outcome (group 2 HR: 1.70, 95% CI: 1.05-2.71; group 3 HR: 2.50, 95% CI: 1.44-4.30; P < 0.001). Conclusions The noninvasive hemodynamic approach provides an alternative and promising method to stratify the risk of clinical outcome in patients with ATTR-CM, potentially improving management strategies.
Source: JACC Advances
Authors: Matteo Serenelli, Anna Cantone, Aldostefano Porcari, Marco Pozzan, Marco Merlo, Gianfranco Sinagra, Gabriele Guidi Colombi, Beatrice Dal Passo, Federico Sanguettoli, Matteo Arzenton, Daniele Maio, Martina Vitali, Giulia Casolari, Jacopo Bonini, Alberto Cipriani, Laura De Michieli, Donato Mele, Giulio Sinigiani, Daniela Tomasoni, Marco Metra, Rita Pavasini, Simone Biscaglia, Gianluca Campo
Institutions: Arcispedale Sant'Anna, University of Trieste, The Royal Free Hospital, ERN GUARD-Heart, Azienda sanitaria universitaria Giuliano Isontina, University College London, University of Padua, Azienda Ospedale - Università Padova, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,936
OpenAlex ID: W7214898030