Aldostefano Porcari, Beatrice Dal Passo, Lucia Venneri, Alberto Aimo, Zehra Irem Sezer, Francesco Bandera, Yousuf Razvi, A Sheikh, Josephine Mansell, Muhammad U. Rauf, Elisa Zaro, Gaia Giampieri, Clara Burgel, Raffaele De Caterina, Michele Emdin, Aviva Petrie, Daniel Knight, Ruta Virsinskaite, T Kotecha, A D Wechalekar, Helen Lachmann, C J Whelan, William E. Moody, Ana Martinez-Naharro, Karola Jering, S D Solomon, Philip N. Hawkins, Julian D. Gillmore, Marianna Fontana
BACKGROUND: Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) remain at risk of cerebrovascular events even when in sinus rhythm (SR), yet the majority of these patients are unrecognized. OBJECTIVES: This study sought to identify patients in SR at high risk of cerebrovascular events. METHODS: We analyzed patients diagnosed with ATTR-CM between January 2003 and December 2023 at the UK National Amyloidosis Centre. Left atrial (LA) function was assessed using speckle-tracking strain echocardiography. Atrial electromechanical dissociation (AEMD) was defined as SR on electrocardiogram with absent left atrial strain contraction (LASc). Patients in SR were stratified according to LASc tertiles. The primary outcome was a cerebrovascular event defined as stroke or transient ischemic attack (TIA), whichever occurred first. The secondary outcome was development of atrial fibrillation (AF). Death was treated as a competing event. RESULTS: -VA significantly improved model fit and risk reclassification at 1 year. CONCLUSIONS: LA dysfunction, particularly AEMD and severely impaired LASc, is associated with increased cerebrovascular events in ATTR-CM. Using LAS analysis may refine risk stratification and help identify patients with ATTR-CM in SR who might potentially benefit from intensified extended rhythm monitoring or prophylactic anticoagulation.