Right Ventricular Function and Prognosis in Patients with Transthyretin Amyloid Cardiomyopathy

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an infiltrative disease that impairs the diastolic and systolic function of the heart, affecting both left and right chambers.Objective: To evaluate the frequency of right ventricle (RV) function involvement and its prognostic impact.Methods: A retrospective analysis of a cohort of 154 patients with ATTR-CM in a specialized cardiology center.Clinical, laboratory and echocardiographic data, risk factors and cardiovascular events were collected.The relationship of RV function with prognosis was assessed using the Cox proportional hazards model.Results: Median age was 81 years (interquartile range, IQR, 75-85), and 95% of patients were men.Forty-seven percent of cases had tricuspid annular plane systolic excursion (TAPSE) <17 mm and 52% had RV S-wave <9.5 cm/s.Mean pulmonary pressure was 40 mmHg (IQR 33-50), and 21.7% showed moderate-severe tricuspid regurgitation.During a median follow-up of 528 days (IQR 159-1004), total mortality was 19.3%, cardiovascular mortality 11.8%, hospitalization for heart failure (HHF) 30.5%, and incidence of atrial fibrillation (AF) 30.4%.TAPSE was an independent predictor of total mortality (HR 0.847, 95% CI 0.730-0.983,p=0.028), cardiovascular mortality (HR 0.725, 95% CI 0.600-0.875,p=0.001),HHF (HR 0.859, 95% CI 0.755-0.977,p=0.001), and AF (HR 0.841, 95% CI 0.727-0.972,p=0.019).Conclusion: Right ventricular dysfunction is frequent in ATTR-CM.TAPSE, as a simple parameter, independently predicts mortality, cardiovascular events and AF in the mid-term.