Combined assessment of left ventricular and atrial function for transthyretin amyloid cardiomyopathy

Transthyretin amyloid cardiomyopathy (ATTR-CM) is characterized by extracellular deposition of misfolded transthyretin protein in the myocardium, leading to progressive dysfunction of both the left ventricle (LV) and left atrium (LA). While LV impairment has traditionally been emphasized in risk stratification, emerging evidence suggests that LA dysfunction may also contribute significantly to clinical outcomes. However, the prognostic implications of combining both LV and LA functional assessments in ATTR-CM remain unknown. We retrospectively evaluated 139 patients with ATTR-CM treated with disease-modifying therapies. LV and LA function were assessed using global longitudinal strain (GLS) and LA reservoir strain via speckle-tracking echocardiography. Patients were categorized into three groups based on median GLS (10.9%) and LA strain (9.5%): (1) preserved both LV and LA function, (2) impaired both, and (3) preserved only one. The primary endpoint was a composite of cardiovascular death or hospitalization for heart failure, with a median follow-up of 1.50 years after treatment initiation. Patients with preserved function in both chambers experienced significantly fewer cardiovascular events, while those with impairment in both had the highest event rate. Patients with preserved function in only one chamber showed intermediate outcomes. In multivariable Cox regression analysis, combined LV and LA dysfunction was independently associated with adverse events (HR 8.89, 95% CI 2.38-44.20, P = 0.001). In conclusion, simultaneous evaluation of LV and LA function provides enhanced prognostic stratification in patients with ATTR-CM. This combined approach may support more accurate risk assessment and guide individualized therapeutic strategies in clinical practice.