Myocardial work indices in the short‐term prognosis of light‐chain cardiac amyloidosis: Incremental value beyond traditional staging models and echocardiographic parameters

Summary Light‐chain cardiac amyloidosis (AL‐CA) causes structural and functional cardiac impairment. Myocardial work (MW), integrating left ventricular strain with afterload, may improve risk stratification. This study assesses the prognostic value of MW in AL‐CA patients and its potential to enhanc...

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Published in:British journal of haematology Vol. 207; no. 5; pp. 1962 - 1972
Main Authors: Meng, Fangmin, Li, Jing, Zhao, Rui, Wu, Yuanfeng, Liu, Yu, Yang, Yiming, Yang, Yang, Zhou, Nianwei, Dong, Lili, Kong, Dehong, Chen, Haiyan, Shu, Xianhong, Liu, Peng, Pan, Cuizhen
Format: Journal Article
Language:English
Published: England Blackwell Publishing Ltd 01.11.2025
Subjects:
Aged
Amyloidosis
Biopsy
Cardiomyopathies - diagnosis
Cardiomyopathies - diagnostic imaging
Cardiomyopathies - mortality
Cardiomyopathies - physiopathology
Creatinine
Echocardiography - methods
Female
Heart rate
Humans
Immunoglobulin Light-chain Amyloidosis - diagnosis
Immunoglobulin Light-chain Amyloidosis - diagnostic imaging
Immunoglobulin Light-chain Amyloidosis - mortality
Immunoglobulin Light-chain Amyloidosis - physiopathology
light‐chain amyloidosis
Male
Medical prognosis
Middle Aged
Mortality
myocardial work
Pleural effusion
Prognosis
prognosis cardiac amyloidosis
Prospective Studies
Structure-function relationships
myocardial work
prognosis cardiac amyloidosis
light‐chain amyloidosis
ISSN:0007-1048, 1365-2141, 1365-2141
Online Access:Get full text
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Summary:Summary Light‐chain cardiac amyloidosis (AL‐CA) causes structural and functional cardiac impairment. Myocardial work (MW), integrating left ventricular strain with afterload, may improve risk stratification. This study assesses the prognostic value of MW in AL‐CA patients and its potential to enhance traditional staging models. We prospectively enrolled biopsy‐confirmed AL‐CA patients between 2022 and 2024. MW indices, including global work index (GWI) and global constructive work (GCW), were derived using EchoPAC 206. The primary outcome was all‐cause mortality. Among 96 AL‐CA patients (mean age: 62.8 ± 10.2 years; 70% male), 28 died during a median follow‐up of 190 days. Multivariate Cox analysis identified GWI and GCW as independent predictors of mortality after adjusting for creatinine, heart rate, New York Heart Association class, Mayo 2012 class and pleural effusion. Kaplan–Meier analysis showed worse survival for GWI ≤840 mmHg% or GCW ≤1031 mmHg%. The likelihood ratio χ2 test demonstrated that GWI and GCW significantly improved the predictive power of the Mayo 2012 and Euro 2015 models (p < 0.001). MW indices, particularly GWI and GCW, are independent predictors of short‐term mortality in AL‐CA patients, thereby improving existing risk models and providing valuable prognostic insights. Myocardial work parameters (global work index/global constructive work) improve risk stratification in light‐chain cardiac amyloidosis.
Bibliography:Fangmin Meng, Jing Li and Rui Zhao contributed equally to this work and should be considered co‐first authors.
Xianhong Shu, Peng Liu and Cuizhen Pan contributed equally to this work and should be considered co‐corresponding authors.
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ISSN:0007-1048
1365-2141
1365-2141
DOI:10.1111/bjh.70122