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Updated: Sep 17, 2025

Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
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Primary Left Atrial Cardiopathy in Transthyretin Amyloidosis Cardiomyopathy by Multimodality Imaging: Implications

Benay Ozbay1, Corey Rearick1, Bharadwaj S Satyavolu1

  • 1Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

JACC. Cardiovascular Imaging
|July 3, 2025
PubMed

Insights

Thrombotic event risk in transthyretin amyloid cardiomyopathy (ATTR-CM) is linked to primary left atrial (LA) remodeling, not just atrial fibrillation or LA size. This LA cardiopathy is a key factor in ATTR-CM patients.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Cardiac Electrophysiology

Background:

  • Transthyretin amyloid cardiomyopathy (ATTR-CM) is associated with a high risk of thrombotic events (TEs).
  • Understanding the mechanisms driving TE risk in ATTR-CM is crucial for patient management.

Purpose of the Study:

  • To investigate left atrial (LA) remodeling in ATTR-CM.
  • To compare LA remodeling and TE risk in ATTR-CM versus other left ventricular hypertrophy (LVH) phenotypes.
  • To identify independent predictors of TE in ATTR-CM.

Main Methods:

  • Retrospective analysis of 405 subjects undergoing echocardiography, scintigraphy, and electrophoresis.
  • Propensity score matching for age, sex, coronary artery disease, and diabetes.
  • 5-year longitudinal follow-up for thrombotic events (TEs).

Main Results:

  • ATTR-CM patients exhibited reduced left atrial reservoir strain (LASr) and increased LA stiffness compared to LVH controls.
  • LASr in ATTR-CM was depressed independently of diastolic dysfunction and atrial fibrillation (AF).
  • LASr and LA stiffness were independently associated with TEs in ATTR-CM, irrespective of CHA2DS2-VASc score or baseline AF.

Conclusions:

  • Primary LA cardiopathy, characterized by impaired LASr and increased LA stiffness, is associated with TE risk in ATTR-CM.
  • This association is independent of AF, CHA2DS2-VASc score, and LA dilatation.
  • These findings differentiate TE risk factors in ATTR-CM from other LVH phenotypes.
Abstract

Keywords:
cardiac magnetic resonanceleft atriumspeckle tracking strainthrombotic eventtransthyretin amyloidosis

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