Prognostic value of left atrial function in cardiac amyloidosis: a systematic review and meta‑analysis

To evaluate the prognostic value of left atrial (LA) function parameters, assessed by echocardiography or cardiac magnetic resonance, in patients with cardiac amyloidosis. We conducted a systematic review and meta-analysis of cohort studies evaluating the prognostic role of LA function parameters, such as left atrial reservoir strain (LASr), in confirmed light-chain amyloid cardiomyopathy (AL-CM) or transthyretin amyloid cardiomyopathy (ATTR-CM). Twenty studies were included, comprising a total of 3,260 participants. LASr was inversely associated with all-cause mortality (HR: 0.92; 95% CI: 0.88-0.96), although with low certainty of evidence. LASr was also associated with a lower risk of atrial fibrillation (HR: 0.92; 95% CI: 0.88-0.96), likewise with low certainty. Contractile strain was associated with reduced all-cause mortality (HR: 0.83; 95% CI: 0.76-0.91). The LA stiffness index was associated with increased all-cause mortality (HR: 1.17; 95% CI: 1.09-1.26). Other parameters also showed associations with all-cause mortality; however, the number of available studies was insufficient. In patients with cardiac amyloidosis, assessment of LA function provides incremental prognostic information beyond ventricular parameters for identifying individuals at higher risk of adverse clinical outcomes. Nevertheless, the certainty of the evidence is low or very low, which does not support its routine prognostic use.