Real-World Disease Progression in Transthyretin Cardiac Amyloidosis: An Analysis Based on Consensus-Recommended Monitoring Parameters

Background: The transthyretin cardiac amyloidosis (ATTR-CM) is a progressive disease leading to cardiomyopathy and heart failure. The “Expert Consensus on the Monitoring of Transthyretin Amyloid Cardiomyopathy” provides a structured approach for tracking disease progression by utilising a multimodal assessment model (clinical, laboratory biomarker and imaging/ECG).

Methods: We conducted a retrospective analysis of ATTR-CM patients assessed during a routine clinic visit in 2024, which served as the follow-up. Clinical evaluations were performed according to our local protocol, and a prior assessment from approximately one year earlier was retrospectively identified and used as the baseline.

Results: A total of 106 ATTR-CM patients were included (86% male, mean age 79 years). Overall, 11.5% met the criteria for disease progression according to the expert consensus, while 7.8% showed no progression in any of the three assessed categories. Clinical worsening was observed in 29.8% of patients. In the imaging/ECG category, 82.5% showed deterioration in at least one parameter, with echocardiographic findings being the leading contributing factor. In the laboratory category, progression was detected in 39.4% of patients, mostly driven by relevant NT-proBNP elevation.

Conclusion: We applied the assessment model in a real-world cohort, demonstrating that substantial portion of the patients experienced deterioration of key parameters over a relatively short follow-up period. These findings highlight the progressive nature of the disase and the need for regular and critical reevaluation of the disease management.