Echocardiographic factors associated with thromboembolic events in patients with cardiac amyloidosis without atrial fibrillation.

Aims: Cardiac amyloidosis (CA) is associated with various complications, and one of them are thromboembolic events (TEEs), which can significantly impact patients' quality of life. Predicting and managing the risk of these TEEs in patients without atrial fibrillation (AF) pose significant challenges, as many occur independently of AF presence. Several predictors, particularly echocardiographic ones, have been linked to an increased risk, but there is no consensus on stratification or preventive treatment. The main objective was to determine the prevalence of TEEs in a cohort of CA patients without AF and identify echocardiographic predictors.

Methods: A retrospective, single-center study including confirmed CA patients. A prespecified list of variables was defined, and only patients with at least 70 % of these variables were included. Risk rates were analyzed through binary logistic regression, with a significance level set at p < 0.05.

Results: 75 patients were included. Baseline characteristics are depicted in Fig. 1. Fifteen TEEs (20 %) were described, with 80 % being ischemic strokes. While diastolic dysfunction and pulmonary systolic arterial pressure (PSAP) were predictors in univariate analysis, the multivariate backward LR model identified interventricular septum diameter (IVSD) as the sole predictor, OR 1.280 (1.061-1.543), p = 0.010. It is also interesting to mention that analyzing the increase of every 3 mm in SIV, the chance of developing ETES was: OR = 2.095 (1.195-3.671), p = 0.010.

Conclusions: An IVSD evaluated by echocardiography demonstrated good performance capacity as a factor associated with TEEs in this cohort of patients with AC without AF. For every 3 mm increase in IVSD, the risk of developing TEEs doubles.