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While recommendations highlight restrictive filling as a common echocardiographic marker in ATTR-CM, a detailed characterization of diastolic dysfunction (LVDD) severity and differences in prevalence between ATTR-CM genotypes have not been explored. In a well-characterized ATTR-CM cohort, we investigated the prevalence, severity and genotype-specific distribution of LVDD and assessed the added value of left atrial reservoir strain (LASr) for its detection. Diastolic dysfunction was graded by transthoracic echocardiography in 100 patients with ATTR-CM (76 hereditary [ATTRv] and 24 wild-type (ATTRwt) according to current ASE\/EACVI recommendations, with LASr incorporated for comparison. Restrictive filling was observed in only 22% of the cohort and was more common in in ATTRwt compared with ATTRv (59% vs. 14% respectively). Incorporating LASr into LVDD assessment did not change the proportion of patients with restrictive filling pressure but increased the proportion of patients identified with elevated filling pressure from 53% to 68% and reduced indeterminate cases from 13% to 3%. Restrictive filling in uncommon in ATTR-CM and varies by genotype, while incorporation of LASr markedly improves detection of elevated filling pressure. These findings underscore the need for a personalized approach and precision therapy tailored to genotypical differences and comorbidities.<\/jats:p>","DOI":"10.1007\/s10554-026-03667-z","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T03:35:00Z","timestamp":1772595300000},"page":"1325-1333","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Elevated filling pressures but rare restrictive physiology in transthyretin amyloid cardiomyopathy: genotype-specific patterns and the role of left atrial strain"],"prefix":"10.1007","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3041-5309","authenticated-orcid":false,"given":"Fredrik","family":"Edbom","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwin","family":"Venkateshvaran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Arvidsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"issue":"4","key":"3667_CR1","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/S0195-668X(02)00428-1","volume":"24","author":"M Fischer","year":"2003","unstructured":"Fischer M, Baessler A, Hense HW, Hengstenberg C, Muscholl M, Holmer S et al (2003) Prevalence of left ventricular diastolic dysfunction in the community: results from a Doppler echocardiographic-based survey of a population sample. 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All the participants provided written informed consent.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}