What is the clinical evidence from this study?

Study design: Cohort. Population: wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) (n=111). Intervention: Echocardiographic parameters (average E/e′ and RV GLS). Primary outcome: all-cause mortality (HR 1.17, 95% CI 1.04-1.33, p=0.013).

What question did this study set out to answer?

This research evaluates the importance of echocardiographic parameters for predicting mortality in wild-type transthyretin amyloid cardiomyopathy patients.

February 2, 2026

Integrating echocardiographic parameters into prognostic assessment of wild-type transthyretin amyloid cardiomyopathy

Q: What does this research mean for the field?

Higher average E/e′ (HR 1.17) and lower RV GLS (HR 0.82) independently predict mortality in patients with wild-type transthyretin amyloid cardiomyopathy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Elevated average E/e′ (HR 1.17; 95% CI 1.04-1.33) and impaired RV GLS (HR 0.82; 95% CI 0.67-0.99) independently predicted all-cause mortality in patients with wtATTR-CM.

Key Points

This research evaluates the importance of echocardiographic parameters for predicting mortality in wild-type transthyretin amyloid cardiomyopathy patients.
Performed a retrospective study at a single center
Included patients diagnosed with wild-type transthyretin amyloid cardiomyopathy from 2014 to 2024
Analyzed baseline clinical data, biomarkers, and echocardiographic measurements
Used multivariable Cox regression to identify predictors of mortality
41% of the patients died during follow-up
Moderate or severe aortic stenosis was more prevalent in those who died (59% vs. 37.5%)
Elevated average E/e′ was significantly associated with mortality
Right ventricular global longitudinal strain was lower in deceased patients
Echocardiographic parameters independently predicted mortality beyond traditional biomarkers

Study Design

Type

Cohort (n=111)

Multicenter

Structured PICO

Population

111 patients with wild-type transthyretin amyloid cardiomyopathy (mean age 81, 26% female) followed for a median of 31 months.

Outcome

All-cause mortalityhard clinical

Echocardiographic parameters reflecting diastolic dysfunction (E/e′) and right ventricular systolic performance (RV GLS) provide independent prognostic value for mortality in wild-type transthyretin amyloid cardiomyopathy beyond established biomarkers.

Main Result

Hazard Ratio: 1.17 (95% CI 1.04–1.33)

p-value: p=0.013

Abstract

Abstract Background Wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) is a progressive infiltrative cardiomyopathy associated with high mortality. While staging systems incorporating biomarkers such as NT-pro-B-type natriuretic peptide (NTproBNP) and estimated glomerular filtration rate (eGFR) have been proposed to stratify risk, echocardiographic assessment may offer additional prognostic insight. Objective To evaluate the prognostic significance of echocardiographic parameters in predicting all-cause mortality in patients with wtATTR-CM. Methods In this retrospective, single-center study, patients diagnosed with wtATTR-CM between 2014 and 2024 were included. The primary outcome was all-cause mortality. Baseline clinical, biomarker (NT-proBNP, eGFR), and echocardiographic data were analyzed. Comparisons were made between patients who died during follow-up and those who survived. Multivariable Cox regression was used to identify independent echocardiographic predictors of mortality. Results A total of 111 patients were analyzed (74% male, mean age 81 ± 5 years), with a median follow-up of 31 months (IQR 16–39). During follow-up, 46 patients (41%) died. Patients who died had a higher prevalence of moderate or severe aortic stenosis (59% vs. 37.5%, p=0.031), increased interventricular septal thickness (19.0 ± 3.6 mm vs. 17.7 ± 3.1 mm, p=0.041), and elevated average E/e′ (18.2 ± 4.4 vs. 13.5 ± 6.2, p0.001). They also exhibited more impaired myocardial function: - Right ventricular global longitudinal strain (RV GLS): –10.4 ± 4.3% vs. –12.7 ± 4.6%, p=0.010 - TAPSE: 16.2 ± 4.6 mm vs. 18.4 ± 4.5 mm, p=0.016 - Left ventricular GLS: –10.2 ± 4.1% vs. –11.8 ± 3.6%, p=0.034 - Peak atrial longitudinal strain (PALS): 7.8 ± 5.1% vs. 11.5 ± 6.2%, p=0.002 - Left atrial total emptying fraction (LATEF): 24.3 ± 12.3% vs. 34.0 ± 14.4%, p0.001 In multivariate analysis adjusting for NT-proBNP and eGFR, both average E/e′ (hazard ratio HR 1.17; 95% CI 1.04–1.33; p=0.013) and RV GLS (HR 0.82; 95% CI 0.67–0.99; p=0.045) remained independent predictors of mortality. Conclusion Echocardiographic indices reflecting diastolic dysfunction (E/e′) and right ventricular systolic performance (RV GLS) independently predict mortality in patients with wtATTR-CM, beyond established biomarkers. Incorporating these parameters into current risk stratification models may improve prognostic accuracy and inform clinical decision-making.

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