In Tafamidis-treated ATTR-CM patients, impaired RV-FWS <16.95% was linked to doubled mortality risk (HR 2.03, p=0.039) over ~3 years.
Does impaired right ventricular free wall strain predict all-cause mortality in patients with ATTR-CM treated with Tafamidis?
Impaired right ventricular free wall strain (<16.95%) is a significant predictor of all-cause mortality in patients with ATTR-CM treated with Tafamidis, highlighting its value for echocardiographic risk stratification.
Absolute Event Rate: 0% vs 0%
Abstract Background/Introduction The assessment of right ventricular (RV) function is relevant for understanding the pathophysiological complexity of heart failure, particularly in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Right ventricular free wall strain (RV-FWS) is an emerging echocardiographic tool for detecting early RV dysfunction, which may not be fully captured by conventional parameters such as tricuspid annular plane systolic excursion (TAPSE) and provides a more comprehensive assessment of longitudinal myocardial deformation across the entire RV free wall. Purpose To determine the prognostic impact of RV-FWS in ATTR-CM patients. Methods We evaluated 282 ATTR-CM patients who presented between January 2020 and June 2023 and had received at least one year of treatment with Tafamidis. Comprehensive assessment of RV function was performed in patients with adequate echocardiographic windows eligible for analysis of RV-FWS with a RV-specific two-dimensional speckle-tracking analysis software. Using ROC and Youden’s J analysis, an optimal cut-off value for RV-FWS as a marker for risk stratification was determined. The primary endpoint was all-cause mortality following one year of uninterrupted treatment with Tafamidis. Results RV-FWS was investigated in 209 ATTR-CM patients (92.1% male, 6.2% ATTRv) after excluding patients who were lost to follow-up (n=34), died within the first year (n=9) and whose baseline echocardiographic windows deemed not sufficient for RV strain analysis (n=30). During a mean follow-up of 1015 ± 353 days, the primary endpoint occurred in 42 (20%) patients. A RV-FWS cut-off value of absolute 16.95% emerged as robust marker for risk stratification (AUC 0.62 95% CI 0.53-0.72, p0.001). RV-FWS 16.95% (impaired RV-FWS), present in 116 patients at baseline, was associated with a significantly lower survival (HR 2.03 95% CI 1.04-3.98, p=0.039) (Figure). Compared to patients with preserved RV-FWS, those with impaired RV-FWS were more likely to have atrial fibrillation (p0.001), higher heart rates at the time of echocardiographic assessment (p0.001), and concomitantly reduced left ventricular global longitudinal strain (p0.001). Conclusion Impaired contraction pattern of right ventricular free wall, measured as RV-FWS, is associated with worse outcome in ATTR-CM patients treated with Tafamidis. Our findings highlight the importance of this parameter for echocardiographic risk stratification and suggest its potential to enhance future understanding of the complex ventricular contraction patterns in ATTR-CM patients.
Schwarting et al. (Sat,) reported a other. In Tafamidis-treated ATTR-CM patients, impaired RV-FWS <16.95% was linked to doubled mortality risk (HR 2.03, p=0.039) over ~3 years.