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Cardiac amyloidosis across the spectrum of left ventricular function: multimodal functional and prognostic insights

Sabrina Belaidi1,2,3, Mounira Kharoubi1,2,4,5,6,7, Olivier Lairez2,7,8

  • 1French National Reference Centre for Cardiac Amyloidosis, Hospital Henri Mondor, Créteil, Île-de-France, France.

Heart (British Cardiac Society)
|March 13, 2026
PubMed

Insights

Cardiac amyloidosis (CA) presents across all ejection fraction phenotypes, not just preserved. Integrating LVEF, GLS, and CIx improves risk prediction for better patient management.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Amyloidosis Research

Background:

  • Cardiac amyloidosis (CA) is increasingly recognized but often associated with heart failure with preserved ejection fraction (HFpEF).
  • However, CA can manifest across the spectrum of left ventricular ejection fraction (LVEF), including mildly reduced (HFmrEF) and reduced (HFrEF) ejection fraction.
  • Accurate recognition of CA across all LVEF phenotypes is crucial for timely diagnosis and effective risk stratification.

Purpose of the Study:

  • To investigate the spectrum of LVEF phenotypes in cardiac amyloidosis.
  • To evaluate the prognostic relevance of LVEF in conjunction with global longitudinal strain (GLS) and cardiac index (CIx).
  • To develop a prognostic model integrating these parameters for improved risk stratification in CA patients.

Main Methods:

  • A retrospective study of 2244 CA patients (light chain, hereditary transthyretin, wild-type transthyretin amyloidosis) was conducted.
  • LVEF was classified per European Society of Cardiology guidelines.
  • Prognostic value was assessed using Kaplan-Meier analysis and a decision tree combining LVEF, GLS, and CIx, with external validation.

Main Results:

  • While HFpEF was most common, 39% of patients had HFmrEF or HFrEF.
  • Survival varied significantly by phenotype: median survival was 30 months (HFrEF), 40 months (HFmrEF), and not reached (HFpEF).
  • A decision tree integrating LVEF, GLS, and CIx identified four distinct prognostic groups with varying 4-year mortality risks.

Conclusions:

  • Cardiac amyloidosis encompasses the full range of LVEF phenotypes.
  • Combining LVEF, GLS, and CIx significantly enhances prognostic stratification in CA.
  • A multimodal imaging approach is recommended for early diagnosis and personalized management of CA.
Abstract

Keywords:
CardiomyopathiesCardiovascular DiseasesHeart failure

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