Rapid Fire Session

Session: Rapid Fire Session 5: Standardization, Multicenter Clinical Trials (Monitor 2)

Cardiac magnetic resonance differences across cardiac amyloidosis subtypes in a latin american cohort.

Saturday, February 7, 2026

10:43 AM - 10:50 AM

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)

SD

Santiago Decotto, MD

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

Co-Author(s)

CF

Cantora Florencia belen, MD

Resident of Cardiology
Hospital Italiano de Buenos Aires, Argentina
Sebastian Tonso, MD

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

Perez de Arenaza Diego, MD

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

Background: Differences in cardiac magnetic resonance (CMR) findings between subtypes of cardiac amyloidosis have been previously reported. However, information from our region regarding these differences is lacking. The objective of this study was to compare CMR findings between patients with transthyretin cardiac amyloidosis (ATTR) and light-chain cardiac amyloidosis (AL).

Methods: We conducted a retrospective, single-center cohort study including patients diagnosed with ATTR and AL cardiac amyloidosis who underwent CMR between 2012 and 2024. Clinical, echocardiographic, and CMR characteristics were analyzed. Comparisons between both subtypes were performed using appropriate statistical tests.

Results: A total of 124 patients were included (73 ATTR and 51 AL), with a mean age of 72±12 years, 72% were male. ATTR patients were older (79 vs. 63 years; p< 0.001), more frequently male (84% vs. 64%; p< 0.001), and had a higher prevalence of atrial fibrillation at diagnosis (44% vs. 27%; p=0.006). Conversely, AL patients presented with worse functional class at diagnosis (NYHA III–IV: 49% vs. 22%; p=0.005) and a higher prevalence of heart failure (88% vs. 57%; p< 0.001). No significant differences were found in echocardiographic parameters between groups (TABLE 1).

On CMR, ATTR patients showed lower left ventricle ejection fraction (51% vs 58%; p=0.008), larger left ventricular end-diastolic (146 mL vs. 116 mL; p< 0.001) and end-systolic volumes (64 mL vs. 44 mL; p< 0.001), larger left atrial volume (72 mL/m² vs. 58 mL/m²; p=0.04), and a trend toward greater maximal wall thickness (18 mm vs. 17 mm; p=0.07). Regarding right ventricular parameters, ATTR patients had lower ejection fraction (46% vs. 52%; p=0.03) and larger end-diastolic (152 mL vs. 116 mL; p< 0.001) and end-systolic volumes (72 mL vs. 56 mL; p< 0.001). In terms of tissue characterization, ATTR patients showed a higher prevalence of atrial late gadolinium enhancement (left atrium: 91% vs. 66%, p=0.006; right atrium: 89% vs. 69%, p=0.04), along with a trend toward lower native T1 (1119 ms vs. 1142 ms; p=0.06) and T2 mapping values (49 ms vs. 52 ms; p=0.07) (TABLE 2).

Conclusion: In our cohort, patients with ATTR showed more extensive biventricular cardiac chamber involvement compared with those with AL, consistent with international series. Moreover, CMR demonstrated higher sensitivity than echocardiography in identifying phenotypic differences between both subtypes of cardiac amyloidosis.

Clinical and echocardiographic characteristics of patients with ATTR and AL cardiac amyloidosis.
CMR variables
ATTR (n=63)
AL (n=25)
p valor
LVEF, % (SD)
51 (±13)
58 (±13)
0.008
LV EDV, mL (SD)
146 (±41)
116 (±42)
< 0.001
LV ESV, mL [IQR]
64 [50-85]
44 [32-53]
‡< 0.001
LV SV, mL/beat [IQR]
71 [59-86]
57 [50-89]
‡0.21
LV mass, g [IQR]
174 [144-215]
153 [117-203]
‡0.21
Maximal wall thickness, mm (SD)
18 (±3)
17 (±3)
0.07
RV EF, % (SD)
46 (±12)
52 (±13)
0.03
RV EDV, mL [IQR]
152 [124-201]
116 [90-150]
‡< 0.001
RV ESV, mL [IQR]
72 [53-129]
56 [37-70]
‡< 0.001
LA volume, mL/m² [IQR]
72 [59-92]
58 [50-68]
‡0.002
T2 mapping, ms (SD)
49 (±4)
52 (±4)
0.07
Native T1 mapping, ms (SD)
1119 (±52)
1142 (±57)
0.06
CMR with gadolinium contrast (N=105)

LV LGE, % (n)
100 (61)
95 (42)
0.09
RV LGE, % (n)
65 (40)
74 (33)
0.31
LA LGE, % (n)
91 (56)
66 (27)
0.002
RA LGE, % (n)
89 (56)
65 (26)
0.004
ECV, % (SD)
49 (±10)
51 (±12)
0.58
* Variables with normal distribution are expressed as mean ± SD; non-normal variables as median [IQR].
‡ Mann–Whitney test.

LVEF: left ventricular ejection fraction; LV EDV: left ventricular end-diastolic volume; LV ESV: left ventricular end-systolic volume; LV SV: left ventricular stroke volume; RV EF: right ventricular ejection fraction; RV EDV: right ventricular end-diastolic volume; RV ESV: right ventricular end-systolic volume; LA: left atrial LGE: late gadolinium enhancement; ECV: extracellular volume fraction.Clinical and echocardiographic characteristics of patients with ATTR and AL cardiac amyloidosis.

ATTR (n=73)
AL (n=51)
p valor
Age, years (SD)
79 (±7)
63 (±11)
< 0.001
Male sex, % (n)
84 (61)
55 (28)
< 0.001
Hypertension, % (n)
66 (49)
53 (28)
0.36
Dyslipidemia, % (n)
72 (47)
72 (42)
0.79
Diabetes mellitus, % (n)
18 (13)
16 (8)
0.76
Coronary artery disease, % (n)
19 (14)
8 (4)
0.08
Heart failure, % (n)
57 (42)
88 (45)
< 0.001
Atrial fibrillation, % (n)
44 (32)
27 (14)
0.006
NYHA class III–IV, % (n)
22 (16)
49 (25)
0.005
GFR, mL/min/1.73 m² (SD)
59 (±17)
50 (±24)
0.004
NT-ProBNP, pg/mL [IQR]
2898 [1225-5800]
4227 [2032-13000]
‡0.002
HS- troponin, pg/mL [IQR]
52 [35-79]
60 [32-103]
‡0.21
Echocardiography

LVEF, % (SD)
53 (±11)
55 (±9)
0.32
Septal wall thickness, mm [IQR]
16 [14-19]
15 [14-18]
‡0.32
Left atrial volume index, mL/m² (SD)
65 (±18)
60 (±27)
0.49
Global longitudinal strain, % (SD)
-11 (± -7)
-12 (± 4)
0.42
TAPSE, mm [IQR]
19 [16-22]
18 [15-20]
‡0.23
PASP, mmHg (SD)
40 (±13)
40 (±12)
0.81
*Variables with normal distribution are expressed as mean ± SD; non-normal variables as median [IQR].
‡ Mann–Whitney test.

GFR: glomerular filtration rate; HS: high sensitivity; LVEF: left ventricle ejection fraction; TAPSE: tricuspid annular plane systolic excursion; PASP: pulmonary artery systolic pressure. Graphical abstract