Abstract 4140416: Impact of reduced right ventricular function on prognosis or heart failure hospitalization in wild-type transthyretin cardiac amyloidosis

Background： Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) is a disease that is increasingly diagnosed through non-invasive diagnostic procedures, including echocardiography and 99mTc-pyrophosphate scintigraphy, and advances in medical treatment. However, echocardiographic prognostic markers of ATTRwt-CA have not been fully clarified. Aims: The aim of this study was to evaluate physical findings, biomarkers, and echocardiographic parameters related to prognosis and heart failure (HF) in patients with ATTRwt-CA. Methods: Thirty-two consecutive patients diagnosed with ATTRwt-CA by myocardial biopsy at Yamaguchi University Hospital from April 2021 to March 2023 were included. Echocardiographic parameters associated with composite adverse outcomes including all-cause mortality or hospitalization for HF were examined. Results: During an average follow-up period of 542 days,３patients died and 3 patients were hospitalized for HF. The proportion of male was 91%, the mean NYHA was 1.9, and 44% had a history of HF hospitalization. The average of left ventricular ejection fraction (LVEF) was 44.5%, and wall thickness averaged 13.5mm at interventricular septum. At univariate analysis, systolic blood pressure（systolic BP: 121mmHg vs. 99mmHg, p<0.01）, diastolic BP (68mmHg vs. 56mmHg, P<0.05), NT-pro BNP (2304pg/ml vs. 5875pg/ml, p<0.01), right ventricular (RV) basal diameter (37mm vs. 41mm, p<0.05), tricuspid annular plane systolic excursion (16.5mm vs. 14.5mm, p<0.05), right ventricular fractional area change (38% vs. 28%, p<0.01), right atrial volume index (37.2ml/m2 vs. 55.2ml/m2, p<0.05) were significantly associated with the composite adverse outcome. Left-sided echocardiographic parameters including LV diameter, LVEF, stroke volume index, E/E’, global longitudinal strain, and left atrial reservoir strain were not associated with outcome. Conclusion: In ATTRwt-CA, in addition to NT-pro BNP and BP, the presence of decreased RV function may correlate with prognosis or HF admission.