The Prognostic Value of Three-Dimensional Speckle-Tracking Echocardiography-Derived Right Ventricular Function in...

Right ventricular (RV) dysfunction is a key prognostic factor in light-chain cardiac amyloidosis (AL-CA). Although 2-dimensional speckle tracking echocardiography has demonstrated predictive value, 3-dimensional speckle tracking echocardiography (3D-STE) allows for a more comprehensive assessment of RV function. However, data on 3D-STE-based RV evaluation in AL-CA remain limited. This study aimed to assess the prognostic value of RV parameters derived from 3D-STE and their contribution to improving mortality risk prediction.

This prospective study enrolled newly diagnosed patients with biopsy-confirmed AL-CA between 2022 and 2025. Each participant received a comprehensive echocardiography study before the initiation of standard chemotherapy. 3D-STE RV parameters were quantified using dedicated software (4D RV-Function 3; Philips Healthcare). The primary study endpoint was all-cause mortality.

A total of 142 patients (mean age: 63.1 ± 9.5 years; 71.1% male) were included, with 52 (36.6%) reaching the primary endpoint. The median follow-up was 205 days (interquartile range, 208 days). Nonsurvivors exhibited significantly worse biventricular function. In multivariable Cox analysis, 3D RVEF (hazard ratio, 0.94, P < .001) was a powerful independent predictor of mortality after adjustment for sex, age, Mayo 2012 stage, left ventricular global longitudinal strain, and pulmonary arterial systolic pressure. Kaplan-Meier analysis confirmed that a 3D RVEF threshold of 40% identified a high-risk group with significantly worse survival (log-rank, P < .001); this cutoff was consistently prognostic across all disease stages and treatment subgroups. The addition of 3D RVEF to the baseline LVGLS model provided the greatest incremental prognostic value among all RV parameters (C-index increase from 0.804 to 0.828; likelihood ratio χ² = 78.65, P < .001).

3D-STE-derived RVEF is a strong, independent predictor of mortality in AL-CA. A cut-off value of 40% effectively stratifies risk and significantly optimizes prognostic models beyond standard LV metrics. Routine assessment of 3D RV function could enhance risk stratification and guide disease management of patients with AL-CA.