{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:57:24Z","timestamp":1790744244305,"version":"4.1.0"},"reference-count":30,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Recent advances in disease awareness and diagnostic strategies have led to earlier diagnosis and improved survival in patients with light-chain cardiac amyloidosis (AL-CA). However, currently used prognostic staging systems are based on older cohorts and rely mainly on cardiac biomarkers, without incorporating patient-related clinical parameters. Aims: We sought to evaluate contemporary survival outcomes in patients with AL cardiac amyloidosis and to identify clinically available predictors that may improve current risk stratification. Methods: This was a single-center ambispective cohort study including consecutive patients diagnosed with AL cardiac amyloidosis between 2014 and 2024. Results: Ninety-six consecutive patients with AL-CA diagnosed between 2014 and 2024 were included. The mean age was 59.6 \u00b1 11.2 years, and 38 patients (39.6%) were women. During follow-up, 51 patients (53.1%) died. Multivariable Cox regression identified lower systolic blood pressure (SBP) (HR 1.30, 95% CI 1.10\u20131.54; p = 0.002), troponin levels &gt;3\u00d7 the upper reference limit (HR 2.67, 95% CI 1.29\u20135.55; p = 0.008), and advanced New York Heart Association (NYHA) functional class (HR 1.92, 95% CI 1.14\u20133.24; p = 0.014) as independent predictors of mortality. Adding SBP to the Mayo 2012 staging system was associated with a modest improvement in prognostic discrimination (C-index: 0.685 vs. 0.723; \u0394C-index = 0.038) and a modest reduction in prediction error. Conclusions: Lower SBP, marked troponin elevation, and advanced NYHA functional class are independent predictors of mortality in AL-CA. SBP may provide modest incremental prognostic information beyond the Mayo 2012 staging system; however, its added predictive value requires validation in larger independent cohorts.<\/jats:p>","DOI":"10.3390\/diagnostics16193111","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:29:53Z","timestamp":1790267393000},"page":"3111","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refining Risk Stratification in Light-Chain Cardiac Amyloidosis: A Single-Center Ambispective Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8153-5258","authenticated-orcid":false,"given":"Emre","family":"Ozerdem","sequence":"first","affiliation":[{"name":"Department of Cardiology, Y\u0131ld\u0131r\u0131m Beyaz\u0131t University Yenimahalle Training and Research Hospital, 06370 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menekse","family":"Gerede Uludag","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ankara University Faculty of Medicine, 06230 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyhmus","family":"Atan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, K\u0131r\u0131kkale High Specialty Hospital, 06230 K\u0131r\u0131kkale, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0961-6755","authenticated-orcid":false,"given":"Halil","family":"Gulyigit","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Health Sciences T\u00fcrkiye, \u0130zmir Tepecik Training and Research Hospital, 35020 Izmir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9190-0009","authenticated-orcid":false,"given":"M\u00fcge","family":"Akbulut","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ankara University Faculty of Medicine, 06230 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sibel","family":"Turhan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ankara University Faculty of Medicine, 06230 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irem","family":"Dincer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ankara University Faculty of Medicine, 06230 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9433-2054","authenticated-orcid":false,"given":"G\u00fcldane","family":"Cengiz Seval","sequence":"additional","affiliation":[{"name":"Department of Hematology, Ankara University Faculty of Medicine, 06230 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meral","family":"Beksac","sequence":"additional","affiliation":[{"name":"Ankara Liv Hospital, Istinye University, 06680 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Cardiac amyloidosis: Recent advances in the diagnosis and therapy","volume":"47","year":"2019","journal-title":"Turk. Kardiyol. Dern. Ars."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1093\/eurheartj\/ehab072","article-title":"Diagnosis and treatment of cardiac amyloidosis: A position statement of the ESC Working Group on Myocardial and Pericardial Diseases","volume":"42","author":"Rapezzi","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"30","DOI":"10.20517\/2574-1209.2021.106","article-title":"Cardiac amyloidosis: A changing epidemiology with open challenges","volume":"6","author":"Canepa","year":"2022","journal-title":"Vessel Plus"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Rossi, M., Varr\u00e0, G.G., Porcari, A., Saro, R., Pagura, L., Lalario, A., Dore, F., Bussani, R., Sinagra, G., and Merlo, M. (2022). Re-Definition of the Epidemiology of Cardiac Amyloidosis. Biomedicines, 10.","DOI":"10.3390\/biomedicines10071566"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s40271-017-0273-5","article-title":"Light Chain (AL) Amyloidosis: The Journey to Diagnosis","volume":"11","author":"McCausland","year":"2018","journal-title":"Patient"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"12","DOI":"10.4065\/mcp.2010.0480","article-title":"Recent improvements in survival in primary systemic amyloidosis and the importance of an early mortality risk score","volume":"86","author":"Kumar","year":"2011","journal-title":"Mayo Clin. Proc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1007\/s11897-023-00616-y","article-title":"Natriuretic Peptides and Cardiac Troponins: Markers of Disease Progression and Risk in Light Chain Cardiac Amyloidosis","volume":"20","author":"Wees","year":"2023","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"De Michieli, L., Cipriani, A., Iliceto, S., Dispenzieri, A., and Jaffe, A.S. (2024). Cardiac Troponin in Patients with Light Chain and Transthyretin Cardiac Amyloidosis: JACC: CardioOncology State-of-the-Art Review. JACC Cardio Oncol., 6.","DOI":"10.1016\/j.jaccao.2023.12.006"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1200\/JCO.2011.38.5724","article-title":"Revised prognostic staging system for light chain amyloidosis incorporating cardiac biomarkers and serum free light chain measurements","volume":"30","author":"Kumar","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1182\/blood-2018-10-875252","article-title":"Staging systems use for risk stratification of systemic amyloidosis in the era of high-sensitivity troponin T assay","volume":"133","author":"Muchtar","year":"2019","journal-title":"Blood"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2799","DOI":"10.1093\/eurheartj\/ehx589","article-title":"A new staging system for cardiac transthyretin amyloidosis","volume":"39","author":"Gillmore","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.jacc.2022.11.022","article-title":"2023 ACC Expert Consensus Decision Pathway on Comprehensive Multidisciplinary Care for the Patient with Cardiac Amyloidosis: A Report of the American College of Cardiology Solution Set Oversight Committee","volume":"81","author":"Kittleson","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1016\/j.echo.2005.10.005","article-title":"Recommendations for chamber quantification: A report from the American Society of Echocardiography\u2019s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology","volume":"18","author":"Lang","year":"2005","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/S0002-9149(96)00425-0","article-title":"Estimation of left ventricular chamber and stroke volume by limited M-mode echocardiography and validation by two-dimensional and Doppler echocardiography","volume":"78","author":"Devereux","year":"1996","journal-title":"Am. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3054","DOI":"10.1182\/blood.V126.23.3054.3054","article-title":"Prospective Evaluation of Blood Pressure Monitoring and Baroreceptor Reflex Sensitivity (BRS) in Patients with AL Amyloidosis: Prognostic and Pathophysiologic Implications","volume":"126","author":"Kastritis","year":"2015","journal-title":"Blood"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3420","DOI":"10.1182\/blood-2012-12-473066","article-title":"A European collaborative study of treatment outcomes in 346 patients with cardiac stage III AL amyloidosis","volume":"121","author":"Wechalekar","year":"2013","journal-title":"Blood"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1016\/j.jchf.2019.07.007","article-title":"A Changing Landscape of Mortality for Systemic Light Chain Amyloidosis","volume":"7","author":"Barrett","year":"2019","journal-title":"JACC Heart Fail."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"R\u00edos-Tamayo, R., Lecumberri, R., Cibeira, M.T., Gonz\u00e1lez-Calle, V., Alonso, R., Domingo-Gonz\u00e1lez, A., Landete, E., Encinas, C., I\u00f1igo, B., and Blanchard, M.-J. (2024). A Simple Frailty Score Predicts Survival and Early Mortality in Systemic AL Amyloidosis. Cancers, 16.","DOI":"10.20944\/preprints202404.0717.v1"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1007\/s00392-020-01799-3","article-title":"Diagnosis and treatment of cardiac amyloidosis: Position statement of the German Cardiac Society (DGK)","volume":"110","author":"Yilmaz","year":"2021","journal-title":"Clin. Res. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3426","DOI":"10.1182\/blood-2010-05-286567","article-title":"The combination of high-sensitivity cardiac troponin T (hs-cTnT) at presentation and changes in N-terminal natriuretic peptide type B (NT-proBNP) after chemotherapy best predicts survival in AL amyloidosis","volume":"116","author":"Palladini","year":"2010","journal-title":"Blood"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/j.cardfail.2020.08.015","article-title":"Uric Acid Is a Biomarker of Oxidative Stress in the Failing Heart: Lessons Learned from Trials with Allopurinol and SGLT2 Inhibitors","volume":"26","author":"Packer","year":"2020","journal-title":"J. Card. Fail."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"297","DOI":"10.4065\/83.3.297","article-title":"Serum uric acid: Novel prognostic factor in primary systemic amyloidosis","volume":"83","author":"Kumar","year":"2008","journal-title":"Mayo Clin. Proc."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Katznelson, E., Jerosch-Herold, M., Cuddy, S.A.M., Clerc, O.F., Benz, D.C., Taylor, A., Rao, S., Kijewski, M.F., Liao, R., and Landau, H. (2024). Mechanisms of left ventricular systolic dysfunction in light chain amyloidosis: A multiparametric cardiac MRI study. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1371810"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.jcmg.2009.11.013","article-title":"Prognostic significance of strain Doppler imaging in light-chain amyloidosis","volume":"3","author":"Koyama","year":"2010","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.cardfail.2018.07.001","article-title":"Myocardial Contraction Fraction by M-Mode Echocardiography Is Superior to Ejection Fraction in Predicting Mortality in Transthyretin Amyloidosis","volume":"24","author":"Rubin","year":"2018","journal-title":"J. Card. Fail."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"61","DOI":"10.3109\/13506129.2014.994202","article-title":"The myocardial contraction fraction is superior to ejection fraction in predicting survival in patients with AL cardiac amyloidosis","volume":"22","author":"Tendler","year":"2015","journal-title":"Amyloid"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lei, C., Zhu, X., Hsi, D.H., Wang, J., Zuo, L., Ta, S., Yang, Q., Xu, L., Zhao, X., and Wang, Y. (2021). Predictors of cardiac involvement and survival in patients with primary systemic light-chain amyloidosis: Roles of the clinical, chemical, and 3-D speckle tracking echocardiography parameters. BMC Cardiovasc. Disord., 21.","DOI":"10.1186\/s12872-021-01856-3"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"102716","DOI":"10.1016\/j.jocmr.2026.102716","article-title":"Characteristics and clinical significance of myocardial work in cardiac light-chain amyloidosis: Pressure-volume loop analysis based on cardiovascular magnetic resonance","volume":"28","author":"Liang","year":"2026","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"345","DOI":"10.31083\/j.rcm2310345","article-title":"Emerging from the Darkness. Sudden Cardiac Death in Cardiac Amyloidosis","volume":"23","author":"Cammalleri","year":"2022","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Li\u017cewska-Springer, A., S\u0142awi\u0144ski, G., and Lewicka, E. (2021). Arrhythmic Sudden Cardiac Death and the Role of Implantable Cardioverter-Defibrillator in Patients with Cardiac Amyloidosis\u2014A Narrative Literature Review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10091858"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3111\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:18:13Z","timestamp":1790741893000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":30,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["diagnostics16193111"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16193111","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]}}}