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Hidden Atrial Dysfunction Raises Stroke Risk in People with Transthyretin Amyloid Cardiomyopathy

Strategic Insights

— 2 min read

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive condition that stiffens the heart muscle, potentially leading to a higher risk of stroke, despite a normal heart rhythm. Research presented at the American Heart Association's Scientific Sessions 2025 suggests that a non-invasive risk assessment tool may help identify individuals with ATTR-CM who are at increased risk of stroke due to hidden atrial dysfunction. Study authors found that people with poor contraction of the atria were more than three times as likely to experience a stroke or transient ischemic attack (TIA) compared to those with normal heart rhythm and normal atrial contraction. The study also revealed that the risk pattern was consistent across different genetic subtypes of ATTR amyloidosis and disease stages, indicating that atrial dysfunction may be a common driver of stroke risk in this condition.

Key Takeaways:

  • People with transthyretin amyloid cardiomyopathy (ATTR-CM) and poor contraction of the atria are more than three times as likely to experience a stroke or transient ischemic attack (TIA) compared to those with normal heart rhythm and normal atrial contraction.
  • A total of 2,310 adults with ATTR-CM (average age 76 years, 86% males and 74.5% with wild-type ATTR) were included in the analysis, which covered a period from January 2003 to December 2023.
  • The study found that atrial dysfunction represents a common driver of stroke risk in ATTR-CM, with the risk pattern being consistent across different genetic subtypes of ATTR amyloidosis and disease stages.
  • Researchers developed a risk-prediction tool that uses two measures widely available on echocardiograms to measure the mechanical function of the atrial chamber.
  • The tool identified that individuals with poor contraction of the atria were at significantly higher risk of stroke, with a rate of about 9 strokes per 100 people each year in the highest-risk group.
  • The study's findings suggest that a non-invasive risk assessment tool may help identify individuals with ATTR-CM who are at increased risk of stroke due to hidden atrial dysfunction.
  • The study is observational, so it cannot prove cause and effect, and the next step is to conduct a prospective, multicenter study to investigate how this tool works and if preventive anticoagulation can lower the risk of stroke in people with atrial electromechanical dissociation.

Statistics:

  • 2,310 adults with transthyretin amyloid cardiomyopathy (ATTR-CM) were included in the analysis, with an average age of 76 years, 86% males, and 74.5% with wild-type ATTR.
  • 5% of patients experienced a stroke or TIA and 31% developed atrial fibrillation during the 34-month follow-up period.
  • The study found that individuals with poor contraction of the atria were at significantly higher risk of stroke, with a rate of about 9 strokes per 100 people each year in the highest-risk group.

Sources:

  • American Heart Association news release (May 2025)
  • American Heart Association news release (Nov. 2022)
  • American Heart Association health information: About Transthyretin Amyloid Cardiomyopathy
  • COMTEX_469991173/2549/2025-11-03T06:34:51
  • The American Heart Association's Scientific Sessions 2025 press release (Nov. 2025)

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