ArticleThe international journal of cardiovascular imaging2026
Distribution and prognostic implications of right and left ventricular systolic dysfunction in wild-type transthyretin amyloid cardiomyopathy.
Article in The international journal of cardiovascular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
We aimed to characterize the prevalence and severity of left ventricular (LV) and right ventricular (RV) systolic dysfunction and their prognostic implications in wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM). We enrolled 256 consecutive contemporary ATTRwt-CM patients. LV systolic function was assessed by LV ejection fraction (LVEF), global longitudinal strain (LV-GLS), and stroke volume index (SVi), while RV systolic function was assessed using Tricuspid Annular Plane Systolic Excursion (TAPSE). At ATTRwt-CM diagnosis time, median LVEF was 47.5% (Q1-Q3: 40.7%-54.3%). Preserved LVEF (≥ 50%) was observed in 43.4% of patients, mildly-reduced LVEF (40–49%) in 34.4%, and reduced LVEF (< 40%) in 22.3%. LV-GLS (absolute value: 11.9 ± 3.3%) and SVi (28.6 mL/m²; Q1–Q3: 23.3–34.4) were moderately reduced. Among patients with preserved LVEF, 90% had impaired LV-GLS and 57% reduced SVi. Impaired LVEF (< 50%) was associated with higher all-cause mortality compared with preserved LVEF (adjusted hazard ratio [aHR] 2.0; 95% CI: 1.26–3.17). TAPSE was 17.7 ± 5.1 mm and demonstrated an independent association with mortality (aHR 0.92; 95% CI: 0.88–0.96). One-third of patients had preserved LVEF and TAPSE (≥ 18 mm), showing the most favorable prognosis compared with patients with impaired LVEF, TAPSE, or both. LV and RV systolic dysfunction are common at the time of ATTRwt-CM diagnosis and span a broad spectrum of severity. LV-GLS and SVi are frequently impaired despite preserved LVEF, highlighting the need for a multiparametric assessment of LV function. Incorporating TAPSE for RV evaluation may further refine risk stratification, particularly when LVEF is preserved.
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