Prognostic Value of Echocardiographic and Cardiac Magnetic Resonance (CMR) Parameters of Right Ventricular Function in Cardiac Amyloidosis

Friday, February 6, 2026

4:13 PM - 4:20 PM

Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)

Presenting Author(s)

Sebastian Tonso, MD

Medical associated
Hospital Italiano de Buenos Aires
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina

Primary Author(s)

Sebastian Tonso, MD

Medical associated
Hospital Italiano de Buenos Aires
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina

Co-Author(s)

SD

Santiago Decotto, MD

Faculty
Hospital Italiano de Buenos Aires
Buenos Aires, Buenos Aires, Argentina
CF

Cantora Florencia belen, MD

Resident of Cardiology
Hospital Italiano de Buenos Aires, Argentina
PD

Pilar Domenech, MD

Cardiologist
Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
Santiago del castillo, MD

Cardiologist
Hospital Italiano de Buenos Aires
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
BR

Blanco Rocio, MD

Cardiologist
Hospital Italiano de Buenos Aires
Capital federal, Buenos Aires, Argentina
DP

Diego Perez de Arenaza, MD

Cardiologist Staff, Cardiology Department
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Background: Right ventricular (RV) involvement in cardiac amyloidosis (CA) is increasingly recognized as a major determinant of prognosis. However, the evidence on imaging-derived parameters remains limited.

Methods: We retrospectively analyzed 124 patients with biopsy- or imaging-confirmed CA (59% ATTR, 37% AL; mean age 72.5 ± 11.7 years, 72% male). Clinical data, biomarkers, and echocardiographic parameters—TAPSE (Tricuspid Annular Plane Systolic Excursion), PASP (Pulmonary Artery Systolic Pressure), and the TAPSE/PASP ratio (an index of right ventricle–pulmonary artery coupling)—were measured according to current guidelines. CMR parameters, including RVEF (Right Ventricular Ejection Fraction), volumes, late gadolinium enhancement, and T1 mapping/ECV (extracellular volume), were also assessed. The primary endpoint was all-cause mortality. Associations were evaluated using logistic regression (ORs) and Cox regression (HRs), and Kaplan–Meier survival analyses were performed.

Results: During a median follow-up of 63 months, 41 patients (33%) died; due to missing data, 39 deaths were available for multivariate analyses. In univariate logistic regression, echocardiographic measures of RV function and coupling were associated with mortality: lower TAPSE (OR 0.86; 95% CI 0.78–0.95; p=0.003), higher PASP (OR 1.05; 95% CI 1.00–1.10; p=0.035), and a reduced TAPSE/PASP ratio (OR 3.70; 95% CI 1.08–12.74; p=0.038) predicted worse outcomes. CMR-derived RV systolic function was also predictive; each 5% reduction in RVEF was associated with a 21% higher risk of mortality (OR 0.79; 95% CI 0.66–0.94; p=0.007), whereas RV volumes showed no significant associations. Among biomarkers, each doubling of NT-proBNP was independently associated with a 73% increase in the odds of mortality (OR 1.73; 95% CI 1.29–2.33; p< 0.001). Global ECV did not emerge as a significant predictor (HR 0.97; 95% CI 0.93–1.02; p=0.27). Kaplan–Meier curves confirmed worse survival in patients with reduced RVEF and elevated NT-proBNP, while TAPSE and TAPSE/PASP showed only non-significant trends toward poorer outcomes (Figure 1). In multivariate analysis, NT-proBNP remained an independent predictor of mortality (HR 1.64; 95% CI 1.13–2.19; p=0.007). TAPSE/PASP and RVEF remained significant when tested in separate models, but lost statistical significance when included together in the final model (n=56), while TAPSE/PASP showed a strong trend (p=0.094).

Conclusion: NT-proBNP and RVEF by CMR emerged as the strongest and most consistent predictors of mortality, underscoring the complementary role of biomarkers and imaging in risk stratification

TABLE 1. CLINICAL CHARACTERISTICS OF PATIENTS WITH ATTR AND AL CARDIAC AMYLOIDOSIS.

Clinical characteristics

n

Age, years (SD)

72.5 (11.77)

124

Male sex, % (n)

89 (71.77%)

124

Hypertension, % (n)

75 (60.48%)

124

Dyslipidemia, % (n)

64 (51.61%)

124

Diabetes mellitus, % (n)

21 (16.94%)

124

Coronary artery disease, % (n)

18 (14.52%)

124

Heart failure, % (n)

87 (71.9%)

121

Atrial fibrillation, % (n)

46 (37.1%)

123

NYHA class III–IV, % (n)

41 (33.07%)

124

Biomarkers

GFR, mL/min/1.73 m² (SD)

55.17 (20.72)

109

NT-ProBNP, pg/mL [IQR]

3581 [1486-7005]

120

HS- troponin, pg/mL [IQR]

56 [35-88.2]

101

Amyloidosis subtype

ATTR subtype

73 (58.87)

124

AL subtype

46 (37.1)

124

*Variables with normal distribution are expressed as mean ± SD; non-normal variables as median [IQR].

TABLE 2. ECHOCARDIOGRAPHIC AND CARDIAC MAGNETIC RESONANCE PARAMETERS ACCORDING TO SURVIVAL STATUS (SURVIVORS VS NON-SURVIVORS).
Echocardiography
Survivors
Non-Survivors
p value
n
LVEF, % (SD)
54.67 (10.35)
51.15 (11.35)
0.12
92
TAPSE, mm [IQR]
20.14 (4.91)
16.8 (4.86)
‡ <0.001
96
PASP, mmHg (SD)
36.58 (11.57)
43.84 (13.16)
0.028
59
TAPSE/PASP [IQR]
0.51 [0.4-0.75]
0.36[0.26-0.48]
‡ 0.001
56
CMR variables

LVEF, % (SD)
54.87 (11.45)
52 (16.54)
0.296
105
LV EDV, mL [IQR]
136.5 [105-164]
132 [97 -157]
‡ 0.47
99
LV ESV, mL [IQR]
58 [42.5-78]
50 [37-85]
‡ 0.78
99
LV SV, mL/beat (SD)
71.91 (18.5)
64.95 (23.16)
0.16
81
LV mass, g [IQR]
178 (57.45)
172.2 (64.46)
‡ 0.61
95
Maximal wall thickness, mm [IQR]
18 [16-19]
17 [16-20]
0.59
101
RV EF, % (SD)
50.78 (12.12)
43.75 (14.05)
0.009
102
RV EDV, mL [IQR]
77.5 [64-92]
68 [55-75]
‡ 0.39
89
RV ESV, mL [IQR]
63 [44-83]
75.5 [60-130]
‡ 0.04
89
RV SV, mL/beat [IQR]
70 [53-81]
62 [48-84]
‡ 0.45
82
RVi EDV, mL/m2 [IQR]
74 [56.9-95.6]
78 [69.6-102.3]
‡ 0.13
89
RVi ESV, mL/m2 [IQR]
33.38 [25.1-44.18]
43.2[33.8-65.9]
‡ 0.01
89
Native T1 mapping, ms (SD)
1124.52 (57.23)
1132.69 (49.22)
0.54
86
CMR with gadolinium contrast

LV LGE, % (n)
64 (38)
73 (24)
0.41
92
RV LGE, % (n)
97 (58)
100 (33)
0.29
93
ECV, % (SD)
50.21 (11.55)
46.35 (8.34)
0.2
76
* Variables with normal distribution are expressed as mean ± SD; non-normal variables as median [IQR].
‡ Mann–Whitney test.

FIGURE 1. KAPLAN–MEIER SURVIVAL CURVES ACCORDING TO IMAGING AND BIOMARKER-BASED RISK STRATIFICATION IN CARDIAC AMYLOIDOSIS