Primary Left Atrial Cardiopathy in Transthyretin Amyloidosis Cardiomyopathy by Multimodality Imaging: Implications for Thrombotic Events (JIMG August 2025)-Article: Primary Left Atrial Cardiopathy in Transthyretin Amyloidosis Cardiomyopathy by Multimodality Imaging: Implications for Thrombotic Events

Article: Primary Left Atrial Cardiopathy in Transthyretin Amyloidosis Cardiomyopathy by Multimodality Imaging: Implications for Thrombotic Events

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The study investigates left atrial (LA) remodeling in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) and its link to thrombotic events compared to other forms of left ventricular hypertrophy (LVH). High thrombotic event (TE) risk is noted in ATTR-CM, often independent of common risk predictors such as atrial fibrillation (AF) and CHA₂DS₂-VASc scores.<br /><br />Subjects were analyzed using several imaging techniques, including speckle tracking echocardiography and cardiac magnetic resonance (CMR). The study involved 405 participants, with 149 diagnosed with ATTR-CM. Those with non-amyloid LVH served as controls. With propensity score matching, comparisons between ATTR-CM and LVH groups focused on left atrial strain, volume, and stiffness.<br /><br />Findings reveal that ATTR-CM patients had significantly reduced LA reservoir strain (LASr) and increased LA stiffness as opposed to the controls, indicating distinct LA cardiopathy. Unlike non-amyloid LVH phenotypes, ATTR-CM-associated LA changes persisted across severities of diastolic dysfunction and AF states. These modifications in LA structure and function were associated with an independent risk of thrombotic events, indicating a novel risk factor specific to ATTR-CM, unaffected by traditional predictors like AF or CHA₂DS₂-VASc score.<br /><br />The study underscores primary LA cardiopathy in ATTR-CM as a critical contributor to TEs, proposing that LASr and LA stiffness are more predictive of TEs in ATTR-CM than LA volume or traditional clinical risk models. This highlights the importance of assessing these metrics for managing and possibly re-targeting preventive measures against thrombotic events in ATTR-CM patients, suggesting potential areas for future research into targeted therapies.

Keywords

transthyretin amyloid cardiomyopathy

left atrial remodeling

thrombotic events

left ventricular hypertrophy

atrial fibrillation

speckle tracking echocardiography

cardiac magnetic resonance

left atrial strain

LA stiffness

risk predictors