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Final Program


Program-At-A-Glance

Rapid Fire Session

Session: Rapid Fire Session 2: Multicenter Clinical Trials and Cardiomyopathy (Monitor 10)

Hemodynamic Load by CMR-PCWP and Atrial Strain in Transthyretin Cardiac Amyloidosis

Thursday, February 5, 2026
3:45 PM - 3:52 PM  
Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)
Background: Restrictive cardiomyopathy associated with transthyretin cardiac amyloidosis (ATTR-CA) is driven by heart failure (HF) progression and elevated filling pressures. Right-heart catheterization cohorts have shown that most patients with ATTR-CA have abnormal hemodynamics. These abnormal states of chronic pressure overload can lead to LA remodeling and strain changes. Recent trials for ATTR-CA have identified strain as a treatment-responsive marker. However, the full hemodynamic profile, including pulmonary wedge capillary pressure (PWCP), remains unclear in strain and ATTR-CA risk grading. Cardiac magnetic resonance (CMR) PCWP was recently developed and validated from the sex-specific equation by Garg et al. using left atrial volume (LAV), left ventricular mass (LVM), and sex. In this study, we evaluated the CMR-PCWP of patients with ATTR-CA and its correlation to markers of left atrial remodeling and strain.

Methods: We conducted a retrospective, multi-center study of adults with ATTR-CA who underwent CMR (n=96). PCWP was calculated from LAV measurements in contiguous long-axis cine contours and LVM measurements in contiguous short-axis cine contours and applied to the sex-specific CMR-PCWP equation: PCWP (mmHg) = 5.7591 + 0.07505 x LAV (mL) + 0.05289 x LVM (g) − 1.9927 x Sex (male=1, female=0). Strain measurements were completed using independent software (SuiteHeart). Peak Flow Rate (PFR) is the maximum derivative of the LV volume-time curve. A diastolic filling index [PFR (mL/s) / End Diastolic Volume (EDV) (mL)] (1/s) was computed to account for chamber size. Correlations between PCWP and strain measurements were calculated using the Spearman Rank correlation coefficient. Analyses were performed in Python (pandas, matplotlib, Scipy; PyCharm).

Results: We analyzed 96 patients; analysis for LA strain was completed for 50 patients. For our primary outcome, we found that for patients with ATTR-CA, CMR-PCWP strongly correlated with left atrial (LA) reservoir strain (ρ = −0.6, p < 10⁻⁶). Furthermore, the left ventricular (LV) late diastolic strain rate (SRa) has a strong negative correlation with CMR-PCWP (ρ = -0.7, p < 10⁻6). In contrast, the LV early diastolic strain rate (SRe) has low correlation with CMR-PCWP (ρ = −0.26, p = 0.086). LV PFR/EDV is mildly negatively associated with CMR-PCWP (ρ = −0.31, p = 0.002).

Conclusion: Comparisons of CMR-PCWP and diastolic strain reinforce the mechanistic ATTR modification of the left atrium. The strong negative correlation of LA reservoir strain with CMR-PCWP is physiologically expected and accentuated in ATTR-CM, where amyloid infiltration fibrosis reduces LA compliance. CMR-PCWP was found to have a strong negative association with LV SRa and little correlation with LV SRe, suggesting the late diastolic atrial “kick” may be dysfunctional at high CMR-PCWPs in patients with ATTR-CA.

Correlation of CMR-Derived Pulmonary Capillary Wedge Pressure (PCWP) With Left Atrial and Left Ventricular Functional Metrics.