Key result
Contemporary ATTRwt-CM diagnosis linked to milder cardiac disease and lower new-onset AF.
Why the study?
With increasing awareness of ATTR-CM and diagnostic advances making early diagnosis and disease-modifying therapy more feasible, this study compared clinical profiles and outcomes of ATTRwt-CM patients diagnosed during the early recognition phase versus a more mature phase of contemporary practice.
Does diagnosis of wild-type transthyretin amyloid cardiomyopathy during a mature phase of contemporary clinical practice (2023–2025) improve clinical profiles at presentation and reduce long-term outcomes (mortality, heart failure hospitalization, and new-onset atrial fibrillation) compared to diagnosis during an early phase (2020–2022)?
Cohort (n=242)
Yes
Does diagnosis of wild-type transthyretin amyloid cardiomyopathy during a mature phase of contemporary clinical practice (2023–2025) improve clinical profiles at presentation and reduce long-term outcomes (mortality, heart failure hospitalization, and new-onset atrial fibrillation) compared to diagnosis during an early phase (2020–2022)?
Contemporary patients with wild-type transthyretin amyloid cardiomyopathy are being diagnosed at an earlier disease stage with milder cardiac involvement and experience a significantly lower incidence of new-onset atrial fibrillation.
Answers are grounded in this paper and cite their sources.
Supports earlier ATTRwt-CM detection; leaves open whether this improves mortality or HF hospitalization.
Background With increasing awareness of transthyretin amyloid cardiomyopathy (ATTR-CM) and advances in diagnostic techniques, early diagnosis and earlier initiation of disease-modifying therapy have become increasingly feasible. Purpose We sought to compare the clinical profiles and outcomes of patients with wild-type ATTR-CM (ATTRwt-CM) diagnosed during the early phase of ATTR-CM recognition and those diagnosed during a more mature phase of contemporary clinical practice. Methods In this multicenter observational study based on our ATTR-CM cohort, we compared patients diagnosed with ATTRwt-CM between January 2020 and December 2022 (early-phase group) and those diagnosed between January 2023 and December 2025 (mature-phase group). Clinical characteristics at diagnosis were analyzed, and long-term outcomes, including all-cause mortality, cardiovascular death, heart failure hospitalization, and new-onset atrial fibrillation (AF), were evaluated. Results A total of 82 patients were included in the early-phase group and 160 in the mature-phase group. Patients diagnosed during the mature phase tended to be older (P = 0.0698) but exhibited higher baseline serum transthyretin levels (P = 0.0350) and better-preserved renal function, as reflected by higher estimated glomerular filtration rate (P = 0.0400). Baseline NT-proBNP and troponin T levels were significantly lower in the mature-phase group (P = 0.0451 and 0.0031). Echocardiographic parameters indicated less advanced cardiac involvement in the mature-phase group, with a trend toward higher left ventricular ejection fraction (LVEF, P = 0.086), less interventricular septal (IVST, P = 0.0002) and posterior wall (PLVWT, P = 0.0012) thickening, preserved global longitudinal strain (GLS, P = 0.0264), and lower E/e′ (P < 0.0001) and left ventricular mass (P = 0.0044). The prevalence of AF at the time of diagnosis did not differ significantly between the two groups (50% vs. 49%). Although no significant differences were observed in all-cause mortality, cardiovascular death, or heart failure hospitalization during follow-up (log-rank, P = 0.0880, P = 0.1491 and P = 0.4301, respectively), the incidence of new-onset AF was significantly lower in the mature-phase group (log-rank, P = 0.0417). Conclusion These findings suggest that early diagnosis of ATTR-CM has progressed in recent years, and contemporary patients are being diagnosed and treated at an earlier stage of disease, characterized by less advanced cardiac involvement.
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Kondo et al. (2026) conducted a cohort in Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) (n=242). Diagnosis during the mature phase of contemporary clinical practice (January 2023 to December 2025) vs. Diagnosis during the early phase of ATTR-CM recognition (January 2020 to December 2022) was evaluated on New-onset atrial fibrillation (alongside all-cause mortality, cardiovascular death, and heart failure hospitalization) (p=0.0417). Contemporary diagnosis of ATTRwt-CM (2023-2022) was associated with milder cardiac involvement and lower new-onset atrial fibrillation.
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