Key result
Baseline myocardial strain and work parameters were significantly associated with death (34 events) and heart failure hospitalization (12 events) over a median 935 days in 113 ATTR-CM patients.
Why the study?
Estimating disease extent and prognosis in wild-type ATTR-CM remains challenging, prompting investigation into myocardial deformation and work parameters and their changes over time.
Do myocardial deformation and work parameters predict death and heart failure hospitalization in patients with wild-type transthyretin amyloid cardiomyopathy?
Cohort (n=113)
No
Do myocardial deformation and work parameters predict death and heart failure hospitalization in patients with wild-type transthyretin amyloid cardiomyopathy?
Myocardial work and multi-chamber strain parameters provide prognostic value for predicting death and heart failure hospitalization in patients with wild-type ATTR-CM.
Myocardial work parameters may refine ATTR-CM prognostication; leaves open added value beyond standard deformation metrics in larger cohorts.
AIMS: Wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized condition. It remains challenging to estimate the extent of disease and the prognosis for most patients. Myocardial work is a sensitive echocardiographic approach that improves the characterization of myocardial damage. We investigate the parameters of myocardial deformation and work in ATTR-CM patients and their changes over time. METHODS AND RESULTS: We analysed clinical, electrocardiographic, biological, and echocardiographic characteristics in 113 patients [median age 82 (77-85), 90.4% male] diagnosed with wild-type ATTR-CM based on international consensus at a single centre. We compared the data at baseline and 18-month follow-up. Thirty-four patients died and 12 were hospitalized for heart failure at a median follow-up of 935 days (interquartile range 691-1159 days). Left ventricular end-diastolic diameter, left atrial strain during reservoir phase (LASRES), left ventricular longitudinal strain, global work index (GWI), global constructive work significantly decreased from baseline to 18 months, while left ventricular wall thickness increased. Left ventricular ejection fraction, right ventricular free wall strain (FWS), global wasted work (GWW), and global work efficiency did not alter significantly. Strain parameters were identified as prognostic on baseline evaluation using a multivariate analysis: GWI, GWW, FWS, and LASRES. They were significantly associated with the risk of death and hospitalization for heart failure. CONCLUSION: Multi-chamber strain assessment may improve the surveillance of patients with ATTR-CM, and myocardial work parameters may improve clinical risk stratification in this population.
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Antonelli et al. (2023) conducted a cohort in Wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) (n=113). Myocardial deformation and work parameters (GWI, GWW, FWS, LASRES) was evaluated on Death and hospitalization for heart failure. Baseline myocardial strain and work parameters were significantly associated with death (34 events) and heart failure hospitalization (12 events) over a median 935 days in 113 ATTR-CM patients.
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