Key result
Global PALS positively correlates with 6MWT and NT-proBNP but not KCCQ in cardiac amyloidosis.
Why the study?
Cardiac amyloidosis is characterized by diastolic dysfunction, worsening functional capacity, and poor prognosis; the relationship of left atrial strain with functional capacity and its prognostic value remained to be evaluated.
Does global peak atrial longitudinal strain (PALS) correlate with functional capacity and predict clinical outcomes in outpatients with cardiac amyloidosis?
Observational (n=75)
No
Does global peak atrial longitudinal strain (PALS) correlate with functional capacity and predict clinical outcomes in outpatients with cardiac amyloidosis?
Left atrial strain parameters, specifically global PALS and GLS, correlate with functional capacity and provide significant prognostic value for predicting death or heart failure hospitalization in patients with cardiac amyloidosis.
Answers are grounded in this paper and cite their sources.
Global PALS was associated with functional capacity in cardiac amyloidosis; hypothesis-generating and should not yet change practice.
Background: Cardiac amyloidosis (CA) is mainly characterized by diastolic dysfunction, with gradually worsening functional capacity and poor prognosis. Left atrial (LA) strain by speckle tracking echocardiography (STE) is an index of diastolic function and heart failure (HF) symptoms. The aim of this study was to evaluate the relationship of LA strain with functional capacity in CA and the potential prognostic value of speckle tracking variables. Methods: In this single-center study, we prospectively enrolled consecutive outpatients with CA (n = 75). Clinical, echocardiographic evaluation, six-minute-walking-test (6MWT) and Kansas City Cardiomyopathy Questionnaire (KCCQ) were performed on the same day. The primary endpoint was the correlation between global peak atrial longitudinal strain (PALS) and NTproBNP, 6MWT score, and KCCQ. The secondary endpoint was a combination of all-cause or cardiovascular death and HF hospitalization. Results: Overall, 48 ATTR and 27 AL patients (74 ± 11 years, 84% male) were enrolled. Global PALS showed a significant direct correlation with N-terminal-pro-brain natriuretic peptide (NTproBNP, p = 0.3, p = 0.017) and 6MWT (p = 0.4, R2 = 0.2, p = 0.004), but no significant correlation with KCCQ (p = −0.13, p = 0.3). GLS showed a significant direct correlation with NTproBNP (p = 0.3, p = 0.017) but not with 6MWT and/or KCCQ. Over a mean follow up of 12 ± 3 months, 42 patients reached the combined endpoint. With ROC curves, both global PALS < 13.5% and GLS > −12% provided a good prediction of the combined endpoint (AUC = 0.72 [0.6–0.82] and 0.73 [0.63–0.83], respectively, p < 0.0001), higher than NTproBNP and other echocardiographic parameters. Conclusions: Global PALS is associated with congestion and functional capacity in CA, suggesting its role as a more objective marker of disease severity in CA. Speckle tracking parameters may be used to enhance prognostic stratification in CA.
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Pastore et al. (2026) conducted an observational in Outpatients with cardiac amyloidosis (ATTR or AL) with preserved LVEF and mean age 74 years (n=75). Global peak atrial longitudinal strain (PALS) and global longitudinal strain (GLS) by speckle tracking echocardiography was evaluated on Correlation of global PALS with NT-proBNP, 6-minute walk test (6MWT) and Kansas City Cardiomyopathy Questionnaire (KCCQ) (Correlation coefficient r=0.4 for 6MWT (p=0.004), r=0.3 for NT-proBNP (p=0.017), no significant correlation with KCCQ (r=-0.13, p=0.3), p=0.004 for 6MWT, 0.017 for NT-proBNP). Global PALS correlated positively with 6MWT distance (r=0.4, p=0.004) and NT-proBNP (r=0.3, p=0.017) but not with KCCQ in patients with cardiac amyloidosis.
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