{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T12:42:27Z","timestamp":1794487347550,"version":"4.9.1"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"\n Importance<\/jats:title>\n In transthyretin amyloid cardiomyopathy (ATTR-CM), tricuspid regurgitation (TR) severity may be underestimated by conventional (semi-)quantitative echocardiographic criteria derived from nonamyloid populations, given the restrictive, low-flow hemodynamics characteristic of the disease.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To derive and validate disease-specific prognostic, quantitative TR risk thresholds in ATTR-CM and to compare their prognostic performance with current guideline definitions and the Tricuspid Valve Academic Research Consortium (TVARC) 5-grade extension.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This international, multicenter cohort study was conducted from January 2016 to February 2026 at 8 high-volume tertiary referral centers across Austria, Italy, Germany, and the Netherlands, with data analysis February to May 2026. Patients with newly diagnosed ATTR-CM were enrolled and underwent standardized transthoracic echocardiography with blinded core laboratory quantitative analysis of echocardiography TR severity parameters (vena contracta width [VCW], effective regurgitant orifice area [EROA], and regurgitant volume [RegVol]).<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n TR severity defined by VCW, EROA, and RegVol from blinded core laboratory quantitative analysis and TR severity according to 2025 European Society of Cardiology\/European Association for Cardio-Thoracic Surgery, 2020 American Heart Association\/American College of Cardiology, 2017 American Society of Echocardiography, and 2023 TVARC grading schemes.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Outcomes were all-cause mortality (primary end point) and time to first heart failure hospitalization (HFH; secondary end point).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 1124 patients with newly diagnosed ATTR-CM were enrolled (derivation cohort: n\u2009=\u2009745; validation cohort: n\u2009=\u2009379). Median (IQR) patient age was 80 (75-84) years, and 260 patients (23.1%) were female. Over a median (IQR) follow-up of 25.2 (12.2-43.2) months, 324 patients (28.8%) died and 251 (22.3%) experienced HFH. All TR metrics independently predicted both end points. Spline-derived thresholds delineated intermediate (VCW \u22653 mm; EROA \u22650.15 cm\n 2<\/jats:sup>\n ; RegVol \u226510 mL), high (\u22655 mm; \u22650.25 cm\n 2<\/jats:sup>\n ; \u226520 mL), and extreme risk (\u22658 mm; \u22650.50 cm\n 2<\/jats:sup>\n ; \u226540 mL), with stepwise Kaplan-Meier separation in both cohorts. Whereas the guideline-based and TVARC schemes each classified 130 patients (11.6%) as having severe TR, the proposed framework classified 334 patients (29.7%) as having at least high or extreme risk (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001 for comparison to all other definitions). The framework was independently associated with both end points, with the highest point estimate among the schemes (mortality: hazard ratio [HR], 1.41; 95% CI, 1.23-1.62; HFH: HR, 1.31; 95% CI, 1.12-1.54), and showed superior discrimination over guideline definitions, particularly at later time points.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this multicenter cohort study among patients with ATTR-CM, a validated, risk-based conceptual framework of echocardiographic parameters to quantify TR improved prediction of mortality and HFH over standard classification of TR severity, better reflecting restrictive low-flow pathophysiology and supporting disease-specific TR grading in ATTR-CM.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamacardio.2026.3803","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:30:20Z","timestamp":1788175820000},"page":"1092","source":"Crossref","is-referenced-by-count":3,"title":["Prognostic Thresholds of Tricuspid Regurgitation in Transthyretin Amyloid Cardiomyopathy"],"prefix":"10.1001","volume":"11","author":[{"given":"Laurenz","family":"Hauptmann","sequence":"first","affiliation":[{"name":"Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie K.","family":"Schwarting","sequence":"additional","affiliation":[{"name":"Department of Medicine I, LMU University Hospital, Ludwig Maximilian University of Munich, Munich, Germany"},{"name":"Department of Cardiology, Angiology and Respiratory Medicine, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Tomasoni","sequence":"additional","affiliation":[{"name":"Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy"},{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Zanders","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Frankfurt, Frankfurt, Germany"},{"name":"German Center for Cardiovascular Research, Partner Site Rhein-Main, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Kronberger","sequence":"additional","affiliation":[{"name":"Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Koschatko","sequence":"additional","affiliation":[{"name":"Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, 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Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy"},{"name":"Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Guidi Colombi","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Schwegel","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Serenelli","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, 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