Echocardiography-derived stroke volume holds an independent and additive prognostic value in patients with transthyretin cardiac amyloidosis

Abstract Background Transthyretin cardiac amyloidosis (ATTR-CA) is increasingly recognized as a significant cause of heart failure. Current risk stratification primarily relies on the National Amyloidosis Centre (NAC) staging system, which comprises renal function and NT-proBNP levels. However, the role of cardiac hemodynamics—particularly non-invasive echocardiographic assessment—remains understudied. Given the limitations of right heart catheterization in routine practice, echocardiography offers a practical alternative for evaluating hemodynamics in ATTR-CA. Aims This study aimed to assess the prognostic significance of echocardiography-derived hemodynamic parameters in patients with ATTR-CA, focusing on left ventricular filling pressure (ePCWP) and forward stroke volume index (SVi). Methods We prospectively evaluated consecutive ATTR-CA patients who underwent comprehensive echocardiography. Left ventricular filling pressures were estimated using a validated algorithm (derived from pulmonary capillary wedge pressure, ePCWP; normal