Left atrial (LA) dysfunction, notably impaired LA strain, is prevalent in transthyretin amyloidosis with cardiomyopathy (ATTR-CM) and independently predicts adverse outcomes including mortality, heart failure hospitalizations, and atrial fibrillation.
LA volume index (LAVi), a traditional measure of atrial remodeling, was not predictive of clinical events in this population, highlighting the superior prognostic value of strain-based functional assessment.
Vutrisiran, an RNA silencing therapy targeting transthyretin, mitigated progressive LA functional decline over 30 months, suggesting a beneficial impact on atrial myopathy beyond its known effects on ventricular parameters.
LA strain did not modify the treatment effect of vutrisiran, supporting its consistent benefits across varying degrees of atrial dysfunction in ATTR-CM.
