Left Atrial Strain in ATTR-CM: What the HELIOS-B Secondary Analysis Adds

In a secondary analysis of the phase 3 HELIOS-B randomised trial, Jering and colleagues examined left atrial structure and function in transthyretin amyloidosis with cardiomyopathy (ATTR-CM). Among 644 participants with measurable left atrial strain, impaired reservoir and contractile strain—not left atrial volume index—were independently associated with all-cause mortality, recurrent cardiovascular events, heart-failure hospitalisation, and incident atrial fibrillation.

At 30 months, participants assigned to vutrisiran had less deterioration in left atrial strain than those assigned to placebo. The analysis supports left atrial strain as a potentially informative marker of atrial involvement in ATTR-CM and is consistent with favourable cardiac effects reported for vutrisiran in HELIOS-B.

This does not establish left atrial strain as a stand-alone treatment-selection tool. It was a prespecified or post hoc secondary analysis within a trial population, and treatment decisions require the full clinical picture, local availability, regulatory status, imaging expertise, and specialist amyloidosis assessment.

Editorial note: this is a professional educational summary of a peer-reviewed secondary analysis, not patient-specific treatment advice. Read the original report for methodology, limitations, funding, and author disclosures.