Comparative Outcomes and Cardiac Imaging Features in Light Chain Versus Transthyretin Cardiac Amyloidosis: A Multi-Center Retrospective Cohort Study.

Cardiac amyloidosis, most commonly presenting as immunoglobulin light-chain (AL) and wild-type transthyretin (ATTR-wt) subtypes, has distinct pathophysiological features and prognoses. Accurate differentiation between these forms is critical for patient management. We conducted a multi-center retrospective cohort study of 200 patients (100 AL, 100 ATTR-wt) diagnosed between 2015 and 2022 within the Baptist Health System in the Southern United States. Clinical, biochemical, echocardiographic, and cardiac magnetic resonance imaging data were systematically reviewed. Patients with light-chain amyloidosis were younger, exhibited higher serum proBNP, lower left ventricular ejection fraction, and greater impairment in global longitudinal strain compared with those with transthyretin amyloidosis. Imaging patterns also differed, with subendocardial late gadolinium enhancement predominating in AL and transmural enhancement more frequent in ATTR-wt. Clinically, AL patients experienced substantially higher heart failure hospitalization rates and worse two-year survival. In conclusion, significant demographic, imaging, and outcome differences exist between light-chain and transthyretin cardiac amyloidosis, highlighting the importance of multimodal assessment to guide timely and targeted management strategies.