{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:05:23Z","timestamp":1792209923001,"version":"4.4.0"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>A formal prognostic staging system in wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM), based on echocardiographic imaging, is lacking. We evaluated the prognostic performance of global longitudinal strain (GLS) staging in a large cohort of patients with ATTRwt-CM, including under tafamidis treatment and relative to National Amyloidosis Center (NAC) biomarker staging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>A multicentric, international ATTRwt-CM patient cohort with baseline GLS (distribution quartiles), evaluated by echocardiography, was studied, related to all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The study comprised 816 patients with ATTRwt-CM, median age of 81.5 years, 83% males, and 72% tafamidis initiated. During a 2.2-year median follow-up, 29.7% of patients died. GLS worsened with increasing NAC disease stage (I: \u221214.3%, II: \u221211.6%, III: \u221211.4%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). Median survival per baseline GLS quartile stage 1 (&lt;\u221215.8%), 2 (\u221215.8 to \u221212.9%), 3 (\u221212.8 to \u221210.0%), and 4 (GLS &gt;\u221210.0%) was not met, 6.7, 4.6, and 3.4 years, respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). The median GLS \u221212.8% cutoff predicted 1-year mortality with 74% sensitivity, 52% specificity (area under the curve, 0.73 [95% CI, 0.66\u20130.80];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). GLS was the only independent echocardiographic and strong mortality predictor, independent of other predictors, including age, New York Heart Association class symptoms, NAC stage, and tafamidis treatment (hazard ratio, 1.08 [95% CI, 1.04\u20131.12];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), also when restricted to 591 tafamidis-treated subjects (hazard ratio, 1.15 [95% CI, 1.08\u20131.22];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). Baseline GLS \u221212.8% cutoff value provided further prognostic discriminative ability for mortality within each NAC disease stage stratum (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.050). Likelihood ratio test indicated incremental prognostic value of GLS (staging) over baseline NAC staging (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>GLS is a strong, independent mortality predictor in ATTRwt-CM, irrespective of tafamidis treatment, that may be an adjunct or complementary to biomarker staging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.125.018862","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T10:00:15Z","timestamp":1764842415000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Global Longitudinal Strain for Prognostic Staging in Wild-Type Transthyretin Cardiac Amyloidosis"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1196-3016","authenticated-orcid":true,"given":"Philippe","family":"Debonnaire","sequence":"first","affiliation":[{"name":"Cardiology Department, AZ Sint-Jan Brugge, Belgium (P.D., W.L., E.C., R.T., I.B., S.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5612-127X","authenticated-orcid":true,"given":"Wouter","family":"L\u2019Hoyes","sequence":"additional","affiliation":[{"name":"Cardiology Department, AZ Sint-Jan Brugge, Belgium (P.D., W.L., E.C., R.T., I.B., S.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2677-3389","authenticated-orcid":true,"given":"Erwan","family":"Donal","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centre Hospitalier Universitaire Rennes, France (E.D., M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7414-4056","authenticated-orcid":true,"given":"Nicolas","family":"Verheyen","sequence":"additional","affiliation":[{"name":"Cardiology Department, Medical University Graz, Austria (N.V., D.Z., N.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4780-5247","authenticated-orcid":true,"given":"Delphine","family":"Vervloet","sequence":"additional","affiliation":[{"name":"Cardiology Department, Ziekenhuis Maria Middelares, Gent, Belgium (D.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Dujardin","sequence":"additional","affiliation":[{"name":"Cardiology Department, Algemeen Ziekenhuis Delta, Roeselare, Belgium (K.D., N.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2395-1787","authenticated-orcid":true,"given":"Anne-Catherine","family":"Pouleur","sequence":"additional","affiliation":[{"name":"Cardiology Department, Cliniques Universitaires St. Luc, Brussels, Belgium (A.-C.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca","family":"Dulgheru","sequence":"additional","affiliation":[{"name":"Cardiology Department, CHU Sart-Tilman, Li\u00e8ge, Belgium (R.D., N.d.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2220-4672","authenticated-orcid":true,"given":"Victor","family":"Sarli Issa","sequence":"additional","affiliation":[{"name":"Cardiology Department, Universitair Ziekenhuis Antwerpen, Edegem, Belgium (V.S.I.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3985-3249","authenticated-orcid":true,"given":"Steven","family":"Droogmans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Vrije Universiteit Brussel, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Jette, Belgium (S.D., L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3438-2612","authenticated-orcid":true,"given":"Ruxandra","family":"Jurcut","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Expert Center for Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases \u2018Prof. dr. C.C. Iliescu\u2019, Univeristy of Medicine and Pharmacy \u2018Carol Davila\u2019, Bucharest, Romania (R.J., R.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1562-8365","authenticated-orcid":true,"given":"Madelien","family":"Regeer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Centre, the Netherlands (M.R., N.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0802-9508","authenticated-orcid":true,"given":"Matthias","family":"Dupont","sequence":"additional","affiliation":[{"name":"Cardiology Department, Ziekenhuis Oost-Limburg, Genk, Belgium (M.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4103-515X","authenticated-orcid":true,"given":"Antoine","family":"Bondue","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hopital Erasme and Institut de Recherche Interdisciplinaire en Biologie humaine et mol\u00e9culaire, Universit\u00e9 Libre de Bruxelles, Brussels, Belgium (A. Bondue)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4023-615X","authenticated-orcid":true,"suffix":"Jr","given":"Philippe","family":"Timmermans","sequence":"additional","affiliation":[{"name":"Cardiology Department, Jessa Ziekenhuis, Hasselt, Belgium (P.T., R.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9776-7467","authenticated-orcid":true,"given":"Alexandre","family":"Bohyn","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Katholieke Universiteit Leuven Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Belgium (A. Bohyn)."},{"name":"Department of Biostatistics, Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Univeristeit Hasselt, Belgium (A. Bohyn)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Christiaen","sequence":"additional","affiliation":[{"name":"Cardiology Department, AZ Sint-Jan Brugge, Belgium (P.D., W.L., E.C., R.T., I.B., S.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Wyseure","sequence":"additional","affiliation":[{"name":"Cardiology Department, Algemeen Ziekenhuis Delta, Roeselare, Belgium (K.D., N.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e9lanie","family":"Bezard","sequence":"additional","affiliation":[{"name":"Cardiology Department, Centre Hospitalier Universitaire Rennes, France (E.D., M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0815-6731","authenticated-orcid":true,"given":"David","family":"Zach","sequence":"additional","affiliation":[{"name":"Cardiology Department, Medical University Graz, Austria (N.V., D.Z., N.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8736-9625","authenticated-orcid":true,"given":"Nora","family":"Schwegel","sequence":"additional","affiliation":[{"name":"Cardiology Department, Medical University Graz, Austria (N.V., D.Z., N.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robbe","family":"Knapen","sequence":"additional","affiliation":[{"name":"Cardiology Department, Jessa Ziekenhuis, Hasselt, Belgium (P.T., R.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2795-4388","authenticated-orcid":true,"given":"Lars","family":"Buytaert","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Vrije Universiteit Brussel, Centrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Jette, Belgium (S.D., L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7237-8190","authenticated-orcid":true,"given":"Nils","family":"de Marneffe","sequence":"additional","affiliation":[{"name":"Cardiology Department, CHU Sart-Tilman, Li\u00e8ge, Belgium (R.D., N.d.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5018-1482","authenticated-orcid":true,"given":"Robert","family":"Adam","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Expert Center for Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases \u2018Prof. dr. 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