APCU25OS5 Seeing beyond the scan: prognostic value of echo and biomarkers in ATTR-CM

Introduction Transthyretin cardiac amyloidosis (ATTR-CM) has emerged as an important and treatable cause of heart failure. Cardiovascular magnetic resonance imaging (CMR) features such as T1 mapping and late gadolinium enhancement (LGE), alongside echocardiographic parameters like global longitudinal strain (GLS), are well recognized in ATTR-CM diagnosis. While individual prognostic roles have been studied, their combined value and relation to circulating biomarkers remain less defined. We aimed to assess the long-term prognostic significance of CMR, echocardiographic measures, and biochemical markers in ATTR-CM.Methods In this single-centre study, patients with confirmed ATTR-CM (via cardiac imaging, PYP scintigraphy, genetic testing, or biopsy) underwent CMR (cine, LGE, native T1 mapping), transthoracic echocardiography with GLS, and biomarker assessment (Troponin T, NTproBNP, eGFR). The primary endpoint was a composite of all-cause mortality and heart failure hospitalization. Univariate and multivariate logistic regression were used for the primary outcome, while Cox proportional hazards regression was applied to all-cause mortality. Gillmore stage was also determined.Results Forty patients were identified (Gillmore stage 1: 32%, stage 2: 53%, stage 3: 15%; mean age 75 years; 74% male). Five were excluded due to suboptimal GLS imaging. Over a median 22- month follow-up, 26 of 35 patients (76%) experienced the primary outcome. Higher NTproBNP (p = 0.017), Troponin T (p = 0.003), CMR-derived left atrial volume index (LAVI; p = 0.039), and regional GLS abnormalities were associated with the composite outcome. However, only NT-proBNP (p < 0.001) and TTE-derived GLS (p = 0.03) predicted all-cause mortality on Cox regression, with both remaining significant in multivariate models.Conclusion In advanced ATTR-CM, NT-proBNP and echocardiographic GLS outperform CMR parameters in predicting all-cause mortality. These findings highlight the complementary role of biomarkers and echocardiography in risk stratification, underscoring the importance of a multimodality approach in managing ATTR-CM.