Evolution of echocardiographic parameters during tafamidis therapy in patients with transthyretin cardiac amyloidosis: a real-world cohort study

Background Transthyretin cardiac amyloidosis (ATTR-CA) is characterized by progressive myocardial infiltration leading to structural remodeling and functional impairment. Tafamidis has demonstrated clinical benefit in ATTR-CA; however, real-world data regarding longitudinal echocardiographic evolution during therapy remain limited. Methods We conducted a single-center observational study that included 158 consecutive patients with ATTR-CA receiving tafamidis therapy. Clinical and echocardiographic parameters were assessed at treatment initiation and after 12 months. Continuous variables are presented as median (interquartile range). Paired comparisons between baseline and 12-month measurements were performed using the Wilcoxon signed-rank test. Results The cohort’s median age was 82 years (IQR 77–85), and 131 patients (82.9%) were males. After 12 months of tafamidis therapy, no statistically significant changes were observed in key echocardiographic parameters. Global longitudinal strain remained stable (baseline −11.4% [−14 to −9.1] vs 12 months −12.6% [−15.8 to −10.1], p=0.476). Left ventricular ejection fraction showed no significant variation (50% [42–55] vs 55% [48–55], p=0.773). Similarly, interventricular septal thickness (15 mm [13–16] vs 14 mm [14–15], p=0.855) and posterior wall thickness (14 mm [12–15] vs 14 mm [12.5–14], p=0.740) remained unchanged over follow-up. Conclusions In this real-world cohort of ATTR-CA patients treated with tafamidis, echocardiographic parameters remained stable during the first year of therapy. These findings suggest that treatment with tafamidis has a disease-modifying effect of reflected by attenuation of structural and functional cardiac progression.