In patients with ATTR-CM, incorporating left atrial reservoir strain into echocardiographic assessment increased detection of elevated left atrial pressure from 53% to 68%, while restrictive filling was uncommon (22%) and varied by genotype (59% in ATTRwt vs 14% in ATTRv).
Observational (n=100)
No
Does incorporating left atrial reservoir strain (LASr) improve the detection of elevated filling pressures in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) compared to standard echocardiographic algorithms?
Restrictive filling is uncommon in early ATTR-CM and varies by genotype, but incorporating left atrial reservoir strain into standard echocardiographic algorithms significantly improves the detection of elevated filling pressures.
Effect estimate: Increase from 53% to 68% prevalence of elevated LAP with addition of LASr
Absolute Event Rate: 68% vs 53%
Transthyretin amyloid cardiomyopathy (ATTR-CM) is associated with cardiac stiffness and diastolic dysfunction. While recommendations highlight restrictive filling as a common echocardiographic marker in ATTR-CM, a detailed characterization of diastolic dysfunction (LVDD) severity and differences in prevalence between ATTR-CM genotypes have not been explored. In a well-characterized ATTR-CM cohort, we investigated the prevalence, severity and genotype-specific distribution of LVDD and assessed the added value of left atrial reservoir strain (LASr) for its detection. Diastolic dysfunction was graded by transthoracic echocardiography in 100 patients with ATTR-CM (76 hereditary ATTRv and 24 wild-type (ATTRwt) according to current ASE/EACVI recommendations, with LASr incorporated for comparison. Restrictive filling was observed in only 22% of the cohort and was more common in in ATTRwt compared with ATTRv (59% vs. 14% respectively). Incorporating LASr into LVDD assessment did not change the proportion of patients with restrictive filling pressure but increased the proportion of patients identified with elevated filling pressure from 53% to 68% and reduced indeterminate cases from 13% to 3%. Restrictive filling in uncommon in ATTR-CM and varies by genotype, while incorporation of LASr markedly improves detection of elevated filling pressure. These findings underscore the need for a personalized approach and precision therapy tailored to genotypical differences and comorbidities.
Ekman et al. (2026) conducted an observational in Patients with transthyretin amyloid cardiomyopathy (ATTR-CM), including 76 hereditary ATTRv and 24 wild-type ATTRwt, median age 72 years, 27% female (n=100). Incorporation of left atrial reservoir strain (LASr) into standard echocardiographic diastolic dysfunction assessment vs. Standard 2016 ASE/EACVI diastolic function algorithm using tricuspid regurgitation velocity was evaluated on Prevalence of elevated left atrial pressure (LAP) and restrictive filling pattern in ATTR-CM assessed by echocardiography (Increase from 53% to 68% prevalence of elevated LAP with addition of LASr). In patients with ATTR-CM, incorporating left atrial reservoir strain into echocardiographic assessment increased detection of elevated left atrial pressure from 53% to 68%, while restrictive filling was uncommon (22%) and varied by genotype (59% in ATTRwt vs 14% in ATTRv).
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