Advanced echocardiographic and multimodal insights into cardiac amyloidosis: predictors of heart failure and arrhythmic complications in ATTR and al subtypes

Abstract Background/Introduction Cardiac amyloidosis is a rare but increasingly recognized condition characterized by the deposition of amyloid fibrils in cardiac tissue. Two major forms, transthyretin (ATTR) and immunoglobulin light chain (AL) amyloidosis, differ in pathophysiology, clinical manifestations, and management strategies. This study focuses on the comprehensive characterization of patients with these forms of amyloidosis, highlighting clinical, laboratory, imaging, and functional findings to better understand the disease and its outcomes. Purpose The study aimed to: Characterize the clinical and imaging features of patients with ATTR and AL amyloidosis. Investigate the predictive value of advanced echocardiographic methods, such as global longitudinal strain (GLS), atrial strain, and mechanical dispersion, in relation to arrhythmias and functional complications. Differentiate between wild-type (ATTRwt) and variant (ATTRv) forms and evaluate the impact of specific treatments on clinical outcomes. Methods This retrospective observational study reviewed clinical, laboratory, and imaging data from 58 patients diagnosed with cardiac amyloidosis at a single center between August 2019 and May 2024. Advanced echocardiographic techniques and other modalities, including cardiac magnetic resonance (CMR) and bone scintigraphy, were employed for detailed evaluation. Logistic regression analysis was used to identify associations between echocardiographic parameters and clinical outcomes. Results Out of 58 patients (36 ATTR and 22 AL), significant differences emerged between the groups in terms of disease severity, echocardiographic findings, and treatment outcomes. ATTR patients were predominantly male, with higher body surface area (BSA) and body mass index (BMI). Advanced echocardiographic parameters such as GLS and atrial strain demonstrated predictive value for atrial fibrillation (AF) and functional complications. Logistic regression revealed associations between AF and variables such as age, left atrial volume index (LAVi), and E/e′ ratio. Troponin levels and imaging markers like extracellular volume (ECV) were significantly elevated in AL patients. Specific therapies, including tafamidis for ATTR, showed efficacy in improving clinical outcomes. Conclusions This study underscores the importance of advanced imaging techniques and biomarkers in differentiating ATTR and AL amyloidosis and predicting clinical outcomes. Echocardiographic parameters provide valuable insights into the pathophysiological differences and can guide treatment decisions. Further studies are warranted to explore longitudinal outcomes and optimize management strategies for this complex condition.Echo picture of Cardiac Amyloidosis Echo and EKG/Arrhythmias in ATTR and AL