Background: Cardiac amyloidosis (CA) is mainly characterized by diastolic dysfunction, with gradually worsening functional capacity and poor prognosis. Left atrial (LA) strain by speckle tracking echocardiography (STE) is an index of diastolic function and heart failure (HF) symptoms. The aim of this study was to evaluate the relationship of LA strain with functional capacity in CA and the potential prognostic value of speckle tracking variables. Methods: In this single-center study, we prospectively enrolled consecutive outpatients with CA (n = 75). Clinical, echocardiographic evaluation, six-minute-walking-test (6MWT) and Kansas City Cardiomyopathy Questionnaire (KCCQ) were performed on the same day. The primary endpoint was the correlation between global peak atrial longitudinal strain (PALS) and NTproBNP, 6MWT score, and KCCQ. The secondary endpoint was a combination of all-cause or cardiovascular death and HF hospitalization. Results: Overall, 48 ATTR and 27 AL patients (74 ± 11 years, 84% male) were enrolled. Global PALS showed a significant direct correlation with N-terminal-pro-brain natriuretic peptide (NTproBNP, p = 0.3, p = 0.017) and 6MWT (p = 0.4, R² = 0.2, p = 0.004), but no significant correlation with KCCQ (p = −0.13, p = 0.3). GLS showed a significant direct correlation with NTproBNP (p = 0.3, p = 0.017) but not with 6MWT and/or KCCQ. Over a mean follow up of 12 ± 3 months, 42 patients reached the combined endpoint. With ROC curves, both global PALS < 13.5% and GLS > −12% provided a good prediction of the combined endpoint (AUC = 0.72 [0.6–0.82] and 0.73 [0.63–0.83], respectively, p < 0.0001), higher than NTproBNP and other echocardiographic parameters. Conclusions: Global PALS is associated with congestion and functional capacity in CA, suggesting its role as a more objective marker of disease severity in CA. Speckle tracking parameters may be used to enhance prognostic stratification in CA.

Background: It is known that mitral valve surgery produces an early reduction in hemodynamic overload after the procedure. However, the reduction in left ventricular (LV) ejection fraction (EF) may persist over the long term. Speckle-tracking echocardiography (STE) provides more sensitive indices of cardiac performance in MR. Myocardial work (MW) evaluates LV performance by considering the effect of LV afterload. The aim of this study was to describe the acute and late postoperative changes in cardiac function and hemodynamics using STE and MW indices in patients with primary MR and to find echocardiographic predictors of postoperative symptom improvement. Methods: Consecutive patients with severe MR and preserved LV EF undergoing mitral valve repair or replacement were prospectively enrolled. Exclusion criteria were atrial fibrillation, previous cardiac surgery, and concomitant aortic or coronary surgery. Patients underwent clinical, biohumoral and echocardiographic evaluation before surgery and within one week after surgery during the hospitalization period. Then, 32 of them underwent a new echocardiographic exam, completed by MW, at long-term follow-up. Results: Overall, 42 patients were enrolled (mean age 65 ± 12 years, 50% male, mean LV EF 59 ± 4%). After intervention, 48% of patients showed a reduction in LV EF (n = 20), while most patients showed reductions in STE and MW parameters across all chambers. Particularly, the global work index (GWI) was reduced in 79% of patients (n = 33). After a mean long-term follow-up of 26 ± 5 months, all STE parameters significantly improved in >70% of patients (n = 22), while LV EF maintained its initial reduction. A baseline value of LV GLS > −17.7% identified patients with persistence of symptoms at long-term follow-up (AUC 0.68, p = 0.02). Conclusions: After an initial decline, LV function detected by GLS improved over the long term after mitral valve surgery, paralleling a reduction in symptoms. STE indices might provide additional value for the long-term follow-up of patients undergoing mitral valve repair/replacement.