Key result
Advanced hemodynamic echo staging linked to ~2.5-fold higher risk of death or heart failure hospitalization.
Why the study?
Validated staging systems for ATTR-CM rely exclusively on biomarkers and neglect structural and functional cardiac parameters for prognostic stratification.
Does a noninvasive hemodynamic echocardiographic staging system using SVi and sPAP independently predict mortality and heart failure hospitalization in patients with ATTR-CM?
Cohort (n=293)
Does a noninvasive hemodynamic echocardiographic staging system using SVi and sPAP independently predict mortality and heart failure hospitalization in patients with ATTR-CM?
Hazard Ratio: 2.5 (95% CI 1.44–4.3)
p-value: p=<0.001
A noninvasive hemodynamic echocardiographic approach based on SVi and sPAP effectively stratifies prognostic risk in patients with ATTR-CM.
Noninvasive hemodynamic staging may aid ATTR-CM risk stratification; leaves open whether it extends or replaces biomarker systems pending prospective validation.
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: 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.
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Serenelli et al. (2026) conducted a cohort in Transthyretin amyloid cardiomyopathy (ATTR-CM) (n=293). Hemodynamic echocardiographic staging (Group 3: low SVi/high sPAP) vs. Group 1 (normal SVi and normal sPAP) was evaluated on Composite of all-cause mortality and heart failure hospitalization (HR 2.50, 95% CI 1.44-4.30, p=<0.001). A hemodynamic echocardiographic staging system independently predicted mortality and heart failure hospitalization in ATTR-CM, with the highest risk in group 3 (HR 2.50; 95% CI 1.44-4.30; P<0.001).
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