Evolution and prognostic value of left ventricular deformation and myocardial work parameters in Transthyretin Amyloid Cardiomyopathy.

BACKGROUND

Wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized condition. It remains challenging to estimate the extent of disease and the prognosis for most patients. Myocardial work is a sensitive echocardiographic approach that improves the characterization of myocardial damage.

OBJECTIVE

We sought to investigate myocardial work parameters in ATTR-CM patients and it changes over time.

METHOD

We analyzed clinical, electrocardiographic, biological, and echocardiographic characteristics in 113 consecutive patients (median age 82 [77-85], 90.4% male) diagnosed with wild-type ATTR-CM based on international consensus at a single centre. Baseline and follow up data at 18-month were assessed.

RESULTS

Thirty-four patients died and twelve were hospitalized for heart failure at a median follow-up of 935 days (IQR 691-1159 days). Left ventricular end-diastolic diameter, left atrial strain during reservoir phase (LASr), left ventricular longitudinal strain, Global Work Index (GWI), Global Constructive Work, and TAPSE significantly decreased from baseline to 18 months while wall thickness increased. Left ventricular Ejection Fraction (LVEF), Right Ventricular Free Wall Strain, Global Wasted Work (GWW) and Global Work Efficiency (GWE) did not alter significantly. Using a multivariate analysis, strain parameters were identified as prognostic on baseline evaluation: GWW and RV-free wall-Strain (FWS) especially. They were significantly associated with the risk of death and hospitalization for heart failure.

CONCLUSION

Myocardial Work parameters, particularly GWW, were valuable predictors for outcome in ATTR-CM patients.

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: [e-mail].