Key result
Higher global work efficiency is linked to ~9% lower mortality in AL amyloidosis.
Why the study?
The relationship between echocardiographic myocardial work indices, disease activity, and CMR-derived amyloid burden in AL amyloidosis, as well as their short-term prognostic value in the daratumumab era, required re-evaluation.
Do echocardiographic myocardial work indices predict all-cause mortality and correlate with CMR-derived amyloid burden in patients with biopsy-confirmed light-chain amyloidosis in the daratumumab era?
Cohort (n=82)
Do echocardiographic myocardial work indices predict all-cause mortality and correlate with CMR-derived amyloid burden in patients with biopsy-confirmed light-chain amyloidosis in the daratumumab era?
Echocardiographic myocardial work indices correlate with CMR-measured amyloid burden and provide independent incremental short-term prognostic value for all-cause mortality over Mayo 2012 staging and global longitudinal strain in patients with light-chain amyloidosis.
Should not yet change practice in AL amyloidosis; leaves open whether myocardial work indices enhance prognostication beyond GLS and staging.
Aim To assess echocardiographic myocardial work indices (MWI) in relation to disease activity and cardiac magnetic resonance (CMR)-derived amyloid burden in patients with light-chain (AL) amyloidosis, and to re-evaluate their short-term prognostic value in the daratumumab era. Methods Consecutive patients with biopsy-confirmed AL amyloidosis who underwent echocardiography between September 2024 and September 2025 were enrolled. Clinical and imaging parameters were compared. Left ventricular (LV) global longitudinal strain (GLS) and MWI, which include global work index (GWI) and global work efficiency (GWE), were derived using EchoPAC software. The primary endpoint was all-cause mortality, with follow-up completed in December 2025. Results 82 patients with AL amyloidosis (mean age 63.01 ± 8.63 years; 62.2% male) were included, of whom 74 underwent concurrent CMR. GWI showed moderate correlations with cardiac biomarkers, biventricular systolic function, LV diastolic function, native T1, and extracellular volume (all P < 0.001). Over a median follow-up of 6 months, 26 patients died. Worse prognosis was significantly associated with GLS (HR: 1.14, 95%CI: 1.03-1.26, P = 0.005), GWI (HR: 0.98, 95%CI: 0.96-0.99, P = 0.004), and GWE (HR: 0.91, 95%CI: 0.86-0.98, P = 0.01). GWE remained an independent predictor after multivariable adjustment, and provided incremental prognostic value over Mayo 2012 stage (C index 0.720, χ2 13.604, P < 0.01) beyond that contributed by GLS (C index 0.665, χ2 10.402) and GWI (C index 0.672, χ2 10.886). Conclusion MWI are closely associated with disease activity and CMR-measured amyloid burden in AL amyloidosis. MWI demonstrated significant prognostic utility.graphic abstract
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Liang et al. (2026) conducted a cohort in Light-chain (AL) amyloidosis (n=82). Echocardiographic myocardial work indices (global work efficiency [GWE] and global work index [GWI]) was evaluated on All-cause mortality (HR 0.91, 95% CI 0.86-0.98, p=0.01). Global work efficiency (HR 0.91; 95% CI 0.86-0.98; P=0.01) and global work index (HR 0.98; 95% CI 0.96-0.99; P=0.004) significantly predicted all-cause mortality in AL amyloidosis.
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