Apical sparing is a classic echocardiographic sign in cardiac amyloidosis. New data published in the European Society of Cardiology Conference 2025 suggest it may reflect a more advanced stage of wild-type transthyretin amyloidosis (wtATTR).

The study analyzed 55 patients with histologically confirmed transthyretin amyloidosis. It compared 39 with apical sparing to 16 without the disease. Those with apical sparing demonstrated a significantly higher myocardial amyloid load, consistent with increased Perugini scores, greater septal thickness, and impaired global longitudinal strain. Cardiac biomarkers, including NT-proBNP and troponin, were also elevated in this group, underscoring the association with disease progression.

No significant differences emerged in age, ejection fraction, or left ventricular dimensions. This suggests that apical sparing may capture disease burden beyond conventional measures of systolic function.
These findings strengthen the role of apical sparing as more than a diagnostic clue. It may help identify patients at greater risk and guide therapeutic decisions in wtATTR amyloidosis. “Prospective longitudinal studies are required to validate the prognostic significance of apical sparing and to determine its utility in guiding clinical management strategies.