Cardiac amyloidosis patients with atrial fibrosis face significantly higher risks of adverse events, including death and acute heart failure. These findings were presented at European Society of Cardiology (ESC) Congress 2025, highlighting the prognostic value of atrial fibrosis detected via cardiac magnetic resonance (CMR).

The study included 80 patients with confirmed cardiac amyloidosis, stratified by the presence of atrial fibrosis. Baseline assessments compared demographics, clinical characteristics, echocardiography, and CMR parameters between 39 patients without fibrosis and 41 with fibrosis, with a median follow-up of nearly three years.

Patients with atrial fibrosis exhibited worse functional status, higher biomarkers such as hs-cTNT and creatinine, and impaired cardiac structure and function, including reduced left ventricular ejection fraction and increased LV mass. During follow-up, they experienced higher rates of acute heart failure, syncope, and cardiovascular mortality.

Multivariate analysis confirmed atrial fibrosis as an independent predictor of all-cause mortality (HR 2.66), alongside age, stroke, and NYHA class. The findings suggest that routine CMR assessment of atrial fibrosis can improve risk stratification in cardiac amyloidosis and may inform targeted therapeutic strategies to enhance patient outcomes.