LA function and the atrio-ventricular coupling are more impaired in ATTRwt-CA patients compared to patients with HF alone; especially LARS and LASI are independent predictor for ATTRwt-CA and should be assessed in HF patients with LVH to detect CA.
Before matching, ATTRwt-CA patients and hypertensive HF controls differed significantly in wall thickness, age, sex and coronary disease prevalence.
After propensity score matching, left atrial functional indices remained significantly impaired in ATTRwt-CA patients compared with controls.
In multivariate analysis, only LARS and LASI were independently associated with ATTRwt-CA.
LASI and PACS had the highest diagnostic accuracy for identifying ATTRwt-CA, with LARS also providing significant discrimination.
Adding LASI to the AMYLI and IWT scores significantly improved diagnostic accuracy for detecting ATTRwt-CA.
The authors conclude LARS and LASI should be assessed in HF patients with LVH to detect cardiac amyloidosis.
This study compared 50 patients with wild-type transthyretin cardiac amyloidosis, a disease in which abnormal protein deposits stiffen the heart, with 50 heart failure patients whose thick heart walls were caused by high blood pressure. The researchers used ultrasound of the heart to measure how well the left atrium, the upper chamber that receives blood from the lungs, stretches, contracts and works together with the left ventricle. Even after statistically matching the groups for wall thickness, age, sex and coronary disease, the left atrium worked worse in amyloidosis patients. Two measures stood out: left atrial reservoir strain (how much the atrium stretches) and left atrial stiffness index. A stiffness index above 1.57 and a contraction strain of 6.0% or lower were best at telling amyloidosis from high-blood-pressure heart disease. Adding the stiffness index to two existing diagnostic scores (AMYLI and IWT) improved their accuracy, with AUC values of 0.91 and 0.89. This research suggests that checking left atrial function on ultrasound could help flag possible cardiac amyloidosis in heart failure patients with thickened heart walls. The study was a case-control design in a limited number of patients, so these findings would need confirmation in other settings, and the abstract does not address how this would work in routine care.
Di Lisi D, Bono G, Puccia G, Macaione F, Bongiorno F, Mesi F, et al.. (2026). Left Atrial Strain and Left Atrio-Ventricular Coupling in Heart Failure Patients with Left Ventricular Hypertrophy and Wild-Type Transthyretin Cardiac Amyloidosis.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70666