Re-evaluation of echocardiographic myocardial work in light-chain amyloidosis: insights from the daratumumab era
S Liang, Z Liu, W He, F Wang, D Li, H Yu, J Sun, Y Han, K Wan, Q Zhang, Y Wu, H Huang, Y ChenAbstract
Aim
To assess echocardiographic myocardial work indices (MWI) in relation to disease activity and cardiac magnetic resonance (CMR)-derived amyloid burden in patients with light-chain (AL) amyloidosis, and to re-evaluate their short-term prognostic value in the daratumumab era.
Methods
Consecutive patients with biopsy-confirmed AL amyloidosis who underwent echocardiography between September 2024 and September 2025 were enrolled. Clinical and imaging parameters were compared. Left ventricular (LV) global longitudinal strain (GLS) and MWI, which include global work index (GWI) and global work efficiency (GWE), were derived using EchoPAC software. The primary endpoint was all-cause mortality, with follow-up completed in December 2025.
Results
82 patients with AL amyloidosis (mean age 63.01 ± 8.63 years; 62.2% male) were included, of whom 74 underwent concurrent CMR. GWI showed moderate correlations with cardiac biomarkers, biventricular systolic function, LV diastolic function, native T1, and extracellular volume (all P < 0.001). Over a median follow-up of 6 months, 26 patients died. Worse prognosis was significantly associated with GLS (HR: 1.14, 95%CI: 1.03-1.26, P = 0.005), GWI (HR: 0.98, 95%CI: 0.96-0.99, P = 0.004), and GWE (HR: 0.91, 95%CI: 0.86-0.98, P = 0.01). GWE remained an independent predictor after multivariable adjustment, and provided incremental prognostic value over Mayo 2012 stage (C index 0.720, χ2 13.604, P < 0.01) beyond that contributed by GLS (C index 0.665, χ2 10.402) and GWI (C index 0.672, χ2 10.886).
Conclusion
MWI are closely associated with disease activity and CMR-measured amyloid burden in AL amyloidosis. MWI demonstrated significant prognostic utility.graphic abstract