Abstract Aim This study aimed to evaluate the prognostic value of left and right atrial reservoir strain (LASr, RASr) regarding all-cause mortality and hospitalization due to worsening heart failure (WHF) in patients with Transthyretin Amyloid Cardiomyopathy (ATTR-CM). Methods In this analysis of the prospective Graz hypertrophic cardiomyopathy registry, 89 patients were enrolled for post-processing analyses of echocardiographic studies, performed by blinded investigators. All patients included between February 2019 and October 2023 with a confirmed diagnosis of ATTR-CM according to current guidelines and adequate echocardiographic image quality were enrolled. Patients’ outcomes were retrieved from local medical and health insurance records. Results Median age was 79 (76-82) years, including 10 (11%) women. During a median (interquartile range) follow up of 3 (2-4) years, 29 (33%) patients died, and 27 (30%) patients were hospitalized due to WHF (as seen in the table below). In univariable Cox-regression analysis, LASr and RASr were significantly associated with mortality (LASr HR = 0.898 95% CI 0.828-0.974, p = 0.009; RASr HR = 0.911 95% CI 0.859-0.966, p = 0.002) and RASr was significantly associated with WHF hospitalizations (HR = 0.931 95% CI 0.882-0.983, p = 0.010). According to the ROC analysis, optimal cut-off values for risk-prediction of mortality were 11% for LASr (52% sensitivity, 81% specificity) and 13% for RASr (57% sensitivity, 83% specificity). In a multivariable Cox-regression model adjusted for age, sex, atrial fibrillation, and treatment with tafamidis, LASr and RASr were independent predictors for mortality (LASr HR = 0.912 95% CI 0.833-0.997, p = 0.043; RASr HR = 0.875 95% CI 0.804-0.951, p = 0.002). Cumulative survival is visualized in the figure below. In the adjusted model, RASr further remained an independent predictor of WHF hospitalizations (HR = 0.891 95% CI 0.823–0.965, p = 0.004). Conclusion LASr and RASr are independent predictors for mortality in patients with ATTR-CM, and RASr independently predicts WHF hospitalizations. Further studies are warranted to elucidate on the value of LASr and RASr in prognostic assessments for these patients in clinical practice.Table:Baseline characteristics. Figure:Cumulative survival probability.
Winkelbauer et al. (Sat,) studied this question.