Isolated atrial amyloidosis, the most common form of cardiac amyloidosis caused by atrial natriuretic peptide deposition, is difficult to diagnose with non-invasive tools. An analysis presented at the European Society of Cardiology (ESC) Congress 2025 assessed whether echocardiographic left atrial strain could help identify the condition in patients undergoing cardiothoracic surgery.

The study evaluated 189 patients who had left atrial appendage resections between 2015 and 2024. Amyloid deposition was graded immunohistologically, and cases with moderate-to-severe deposits were classified as amyloidosis-positive. Left atrial strain was measured with transthoracic echocardiography.

Findings showed that 55.5% of patients were amyloidosis-positive. Left atrial reservoir strain values were significantly lower in those with amyloid deposition, and the reduction in strain correlated with the degree of amyloid burden. In multivariable models, lower strain remained an independent predictor of amyloidosis positivity, with an odds ratio of 0.74 (95% CI 0.64–0.85; p<0.001).

These results suggest that impaired atrial strain may be a practical non-invasive marker of isolated atrial amyloidosis, offering insight into early detection of left atrial dysfunction.