Accurate evaluation of ventricular wall thickness remains essential in diagnosing cardiac amyloidosis, yet measurement variability can mask early disease. A large retrospective study published in Progress in Cardiovascular Diseases assessed echocardiographic parameters in 1,845 patients treated for cardiac amyloidosis between 2006 and 2024 at a tertiary amyloidosis center.

The analysis focused on LVWT, RWT, and LVMi to determine diagnostic sensitivity across transthyretin (ATTR-CA) and light chain (AL-CA) subtypes. A significant proportion of patients had normal or mildly increased LVWT (≤1.2 cm), including 13% with AL-CA and 6.5% with ATTR-CA, while 12.2% of AL-CA cases showed markedly elevated LVWT (>2.0 cm).

Among those with interventricular septal and posterior wall thickness ≤1.2 cm, 68% had RWT greater than 0.42. RWT demonstrated higher sensitivity than LVMi for identifying cardiac amyloidosis and was unaffected by sex. Significant inter- and intra-observer variation (standard error ≈1.5 mm) highlights the need for consistent measurement techniques and inclusion of derived indices to improve diagnostic reliability.