A retrospective study on the association between C-Reactive Protein-Albumin-Lymphocyte (CALLY) index and adverse prognosis in patients with chronic heart failure (CHF) at different glucose metabolic states.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors provide cardiovascular and renal protection in type 2 diabetes and chronic kidney disease (CKD). Although both excess and restricted sodium intake are linked to adverse outcomes, the interaction of sodium intake with SGLT2 inhibitors has not been explored. This study aimed to examine how dietary sodium intake affects cardiorenal outcomes and whether canagliflozin modifies these effects. A post hoc analysis of the CREDENCE trial (median follow-up 2.6 years) was conducted in individuals with type 2 diabetes and CKD randomised to canagliflozin 100 mg or placebo. Using a validated formula, we estimated daily sodium intake from urine in 2573 participants, divided into low-normal sodium (LNS; n=1286) and high sodium (HS; n=1287) groups. Outcomes included the following: cardiovascular death or hospitalisation for heart failure; heart failure alone; a composite renal outcome; and all-cause death. Cox models were adjusted for confounders. Sodium intake was additionally analysed as a continuous variable to assess non-linearity. In the placebo group, LNS intake increased the risk of heart failure/cardiovascular death vs HS (adjusted HR [adjHR] 1.56 [95% CI 1.10, 2.23]). Canagliflozin significantly reduced this risk in the LNS group (adjHR 0.48 [95% CI 0.33, 0.70]) but not in the HS group (adjHR 1.05 [95% CI 0.73, 1.53]). Similar patterns were seen for heart failure alone. Sodium intake had no effect on renal outcomes, while canagliflozin reduced renal risk in both the LNS group and the HS group. Neither sodium intake nor canagliflozin influenced all-cause mortality. Continuous modelling revealed a near-linear rise in heart failure/cardiovascular death risk as sodium intake decreased in placebo recipients, while this gradient was flattened with canagliflozin. In individuals with type 2 diabetes and CKD, LNS intake increases the risk of heart failure and cardiovascular death, while renal outcomes are unaffected by sodium intake. Canagliflozin mitigates the increased cardiovascular risk in individuals with LNS intake, while offering renal protection irrespective of dietary sodium. Clinicaltrial.gov NCT02065791.

Machine learning applied to echocardiographic deformation curves for prediction of heart failure and cardiovascular death.

The fibrosis-4 (FIB-4) score is used to identify risk of advanced liver fibrosis. This post hoc analysis investigated its prognostic value for cardiovascular (CV) outcomes and its relevance to the effects of dapagliflozin. DECLARE-TIMI 58 was a randomised, placebo-controlled phase 3 trial investigating dapagliflozin in patients with type 2 diabetes (T2D) and either atherosclerotic cardiovascular disease (ASCVD) or high ASCVD risk. Participants were stratified by baseline FIB-4 scores (< 1.30, 1.30 to < 2.67, and ≥ 2.67). Hazard ratios (HRs) and 95% confidence intervals (CIs) for dapagliflozin versus placebo were calculated for the two primary outcomes (major adverse cardiovascular events [MACE] and the composite of CV death and hospitalisation for heart failure [HHF]). Of 17 160 patients enrolled, 16 361 were included (median follow-up of 4.2 years). Distribution across FIB-4 categories was: < 1.30, n = 9084 (55.5%); 1.30 to < 2.67, n = 6556 (40.7%); and ≥ 2.67, n = 621 (3.8%), with similar ASCVD prevalence across groups (40%-43%). In the placebo arm, the ≥ 2.67 FIB-4 group had the highest event rates for MACE, HHF, CV death, and all-cause death. MACE HRs (95% CIs) for dapagliflozin versus placebo were 0.95 (0.83-1.10), 0.92 (0.79-1.08), and 0.61 (0.38-0.97) across ascending FIB-4 groups. For the CV death and HHF composite endpoint, they were 0.81 (0.67-0.98), 0.90 (0.73-1.10), and 0.50 (0.28-0.90). Dapagliflozin reduced aspartate aminotransferase and alanine aminotransferase levels compared with placebo. Highest FIB-4 scores were associated with increased CV risk in patients with T2D. Dapagliflozin reduced CV risk across FIB-4 categories without significant interactions.

Residual cardiovascular risk persists despite intensive statin therapy in patients with established atherosclerotic cardiovascular disease (CVD). Omega-3 fatty acids, particularly high-dose eicosapentaenoic acid (EPA), have been proposed as adjunctive therapy, yet trial results conflict, likely due to formulation differences. We conducted a formulation-focused meta-analysis to determine whether high-dose EPA-dominant supplementation reduces cardiovascular events and to quantify the impact of mixed EPA/docosahexaenoic acid (DHA) regimens on efficacy. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched MEDLINE, Embase, CENTRAL, and trial registries through May 2025 for randomized controlled trials, including placebo-controlled and open-label designs, of high-dose EPA-dominant omega-3 (≥1.8 g/day; ≥50% EPA) in adults with established CVD or other high-risk settings. Six trials (n = 42,738; 31-85% male) were eligible. Random-effects models generated pooled risk ratios (RRs), with I2 assessing heterogeneity; sensitivity analyses excluded mixed EPA/DHA formulations. Imaging surrogate outcomes were summarized narratively when study modalities were not directly comparable. EPA-based therapy significantly reduced hospitalizations for unstable angina (RR 0.75, 95% CI 0.66-0.87; I2 = 0%). Overall effects on recurrent myocardial infarction and revascularization were not statistically significant, but both became significant after exclusion of STRENGTH, the only mixed EPA/DHA cardiovascular outcomes trial. No significant effect was observed for ischemic stroke, cardiovascular death, or high-sensitivity C-reactive protein (hs-CRP). CHERRY and EVAPORATE both suggested attenuation of plaque progression, but these imaging studies were not pooled because intravascular ultrasound and coronary computed tomography angiography-derived measures were not directly comparable. High-dose EPA-dominant therapy was associated with fewer unstable angina hospitalizations, and formulation appeared to modify clinical benefit. Among blinded, placebo-controlled, cardiovascular outcomes trials, 4 g/day icosapent ethyl is the only formulation independently associated with reduced cardiovascular events. Larger formulation-specific trials are needed to clarify the roles of purified EPA, mixed EPA/DHA regimens, and patient selection. PROSPERO identifier number: CRD420251063069.

Design and rationale of the clinical trial to obtain the highest efficacy of dual antiplatelet therapy after carotid artery stenting in high bleeding risk patients (CHET): A multicenter, randomized, open-label, superiority trial.

Data-driven subtypes of type 2 diabetes and risk of dementia, stroke, and brain structural changes in the UK Biobank.

Associations of accelerated phenotypic aging, genetic risk and lifestyle with incident asthma, subsequent cardiovascular disease and death: A prospective study using multi-state model.

Coronary artery disease (CAD) progression is directly associated with major adverse cardiovascular events and death. This study aimed to construct a pericoronary adipose tissue (PCAT) radiomics model to predict subsequent progression in patients with CAD. Data from 116 patients who had at least 2 coronary computed tomography angiography (CCTA) exams between March 1, 2020, and August 30, 2022, were collected at our institution. Obstructive stenosis, CAD-RADS classification, segment involvement score (SIS), and segment stenosis score (SSS) were noted. The radiomics features of the proximal to the left anterior descending artery, left circumflex artery, and right coronary artery were extracted on CCTA images using fully automated software. According to CAD-RADS, SIS, and SSS, non-progression was identified in 96, 80, and 72 patients and progression was identified in 20, 36, and 44 patients, respectively. All patients were randomly divided into the training and testing cohorts in a 7:3 ratio. Cox regression models were constructed based on PCAT radiomics signatures, and their predictive abilities were measured using receiver operating characteristic curves. We included 116 patients (age 58.00 [53.25, 64.00] years; 78 [67.20%] were male). After screening, 16 PCAT radiomics features were identified as being significantly related to CAD progression. The Cox regression models had area under the curve values of 0.841, 0.838, and 0.725 in the training cohort and 0.818, 0.817, and 0.851 in the testing cohort, respectively, to predict 2-year CAD-RADS, SIS, and SSS progression. PCAT-based radiomics models demonstrated promising performance in predicting subsequent CAD progression. PCAT-based radiomics signatures derived from coronary CT angiography provided incremental predictive value for CAD progression beyond conventional imaging markers (CAD-RADS, SIS, SSS), and may serve as noninvasive imaging biomarkers for individualized risk stratification.

This study investigated the long-term risk of cardiovascular events and all-cause mortality among participants with calcified carotid artery atheroma (CCAA) on panoramic radiographs (PRs) in the Periodontitis and its Relation to Coronary Artery Disease (PAROKRANK) study. In the multicenter, multidisciplinary PAROKRANK study, 805 patients with a first myocardial infarction (MI) and 805 matched controls without MI were recruited at 17 hospitals in Sweden. At baseline, the participants were examined with PR, and in 737 patients and 739 controls, the carotid artery region was assessable. Calcified carotid artery atheromas were identified in 251 (34%) patients and 205 (28%) controls at baseline. The primary endpoint was defined as the first occurrence of all-cause mortality, non-fatal MI, non-fatal stroke, or hospitalization following heart failure after a mean follow-up of 10 years. The risks of cardiovascular events and death were evaluated using event survival analysis and regression models. Participants with bilateral CCAAs, regardless of whether they were patients or controls, had significantly higher mortality and morbidity than those without CCAA (P < .001). The risk of cardiovascular events was increased in the presence of bilateral CCAAs among both controls (hazard ratio = 1.96 [95% CI, 1.21-3.16], P = .006) and patients (1.67 [1.15-2.43], P = .007). Bilateral CCAAs on PRs were an indicator of an increased risk of future cardiovascular events and early death among both controls and patients in the PAROKRANK study. Therefore, dentists can detect CCAA on PR and contribute to identifying individuals in need of medical attention and treatment of cardiovascular disease to prevent morbidity and early death.

To investigate the potential of 18F-FDG and 18F-FAPI PET/CT for characterizing the pathophysiological heterogeneity of in-stent stenosis (ISR) and to assess their ability to differentiate between its clinically subtypes. This prospective study enrolled participants with ISR selected from a cohort registry between December 2024 to August 2025, which was categorized into rapid recurrent ISR (R-ISR) and ordinary ISR (O-ISR) based on recurrence time interval. For vessel-level analysis, coronary arteries without intervention served as control. All participants underwent both 18F-FDG and 18F-FAPI PET/CT to assess coronary uptake and evaluated the performance of maximum standardized uptake value (SUVmax) and maximum target-to-background ratio (TBRmax) in differentiating ISR from control vessels, as well as R-ISR from O-ISR. All patients were followed-up. The primary endpoint was a composite of cardiovascular death, target-vessel-related myocardial infarction, or target-vessel-related revascularization. Differences in the diagnostic performance of PET parameters and associations with outcomes were assessed. Thirty-one participants and 84 vessels were included. ISR vessels (n = 39) demonstrated higher uptake in 18F-FDG and 18F-FAPI than control (n = 45). R-ISR exhibited higher uptake compared to O-ISR on both patient-level (TBRmax: 18F-FAPI, 4.10 ± 1.41 vs. 1.75 ± 0.50; 18F-FDG, 1.18 ± 0.32 vs. 0.86 ± 0.19) and vessel-level (TBRmax: 18F-FAPI, 4.07 ± 1.29 vs. 1.65 ± 0.50; 18F-FDG, 1.16 ± 0.31 vs. 0.90 ± 0.28) (all P ≤ 0.01). 18F-FAPI showed better diagnostic efficacy compared to 18F-FDG (AUC of TBRmax: 0.97 [0.92-1.00] vs. 0.75 [0.58-0.91], P = 0.01]. Six of 31 participants within R-ISR group reached the endpoint. Baseline PET uptake was associated with subsequent outcome (18F-FAPI SUVmax, HR, 2.28 [95%CI: 1.25-5.09], P = 0.02; 18F-FDG SUVmax, HR, 33.2 [95%CI: 4.93-509], P = 0.002). 18F-FAPI and 18F-FDG PET/CT reveals the molecular heterogeneity of ISR, with 18F-FAPI better identifying the rapid-recurrence subtype for advancing risk stratification. NCT05437965. Registered 24 June 2022.

Heart failure with preserved ejection fraction (HFpEF) constitutes a heterogeneous syndrome. We examined whether systolic semilunar regurgitation-systolic aortic regurgitation (SAR) and systolic pulmonary regurgitation (SPR)-identifies a high-risk HFpEF phenotype. In this retrospective single-center study, 412 participants admitted with HFpEF in the past 10years were included and echocardiographies during hospitalization were assessed. Patients were grouped by the presence of SAR and/or SPR on echocardiography. SAR and SPR were quantitatively assessed using the vena contracta width. The endpoint was the 6-year composite of heart failure rehospitalization or cardiovascular mortality. Of 412 patients, 248 had neither SAR nor SPR, 77 had SAR alone, 53 had SPR alone, and 34 had SAR+SPR. SAR associated with older age, larger aortic dimensions, and higher E/e'; SPR associated with higher pulmonary artery systolic pressures and reduced right ventricular function. Over 6years, 219 heart failure rehospitalizations and 63 cardiovascular deaths occurred. The vena contracta width of SAR was an independently predictor associated with the composite endpoint (adjusted hazard ratio 1.259 per 1mm increase, 95% confident interval 1.118-1.417, p<0.0001), alongside atrial fibrillation and E/e'. Conversely, the vena contracta width of SPR had no significant impact on these events. SAR marks a high-risk HFpEF phenotype. Incorporating SAR into routine echocardiographic reporting may improve risk stratification and guide targeted management.

Hypertension is a primary risk factor for cardiovascular mortality and frequently co-occurs with depression and anxiety, though their combined impact remains inadequately characterized in this high-risk population. This study aimed to investigate the associations of depression and anxiety with cardiovascular mortality specifically in adults with hypertension. We analyzed data from the National Health and Nutrition Examination Survey (NHANES). Depression was assessed using the PHQ-9 questionnaire, while anxiety was measured through self-reported days. The associations were evaluated using weighted multivariable cox regression and restricted cubic spline (RCS) models. A total of 3728 participants were included, with a mean follow-up of 9.2years and 285 cardiovascular deaths. In Model3, depression (PHQ-9) was positively associated with cardiovascular mortality (Hazard ratio (HR) [95% CI] 1.07 [1.03-1.10], P < 0.001). When PHQ-9 was categorized into quartiles, the greatest HR in men was observed in Q3 (2.65 [1.09-6.44], P = 0.032) but that for women was in Q4 (3.94 [1.39-11.2], P = 0.01). RCS curve revealed linear positive association between depression and cardiovascular mortality (P-overall < 0.001; P-nonlinear > 0.05). No interaction was observed in the stratified analyses (P > 0.05). Sensitivity analyses showed the HR of Q4 was attenuated in the overall population but remained stable in women (3.97 [1.29-12.2], P = 0.019). No significant association was found between anxiety and cardiovascular mortality (P > 0.05). Depression, but not self-reported anxious days, was positively associated with cardiovascular mortality in hypertensive patients, with a stronger association observed in women.

This meta-analysis aims to evaluate the efficacy and safety of colchicine for the secondary prevention of cardiovascular and cerebrovascular diseases, and examines how dose and treatment duration modify its risk-benefit profile. A meta-analysis comparing colchicine to placebo or standard care was performed. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI), or non-fatal stroke. The secondary endpoint was expanded MACE (eMACE), defined as MACE plus ischemia-driven coronary revascularization. Colchicine significantly reduced the risk of MACE (relative risk [RR] 0.83, 95% confidence interval [CI] 0.72-0.96) and eMACE (RR 0.78, 95% CI 0.64-0.96), with benefits driven by reductions in non-fatal MI and ischemia-driven coronary revascularization. No significant effect was observed on cardiovascular or all-cause mortality. Colchicine increased gastrointestinal adverse reactions (RR 1.90, 95% CI 1.41-2.55) and drug-related adverse event (DAE)-related colchicine discontinuation (RR 1.54, 95% CI 1.06-2.25). Sensitivity analyses revealed that the guideline-recommended dosage (0.5 mg once daily) for > 6 months maintained cardiovascular benefit (MACE RR 0.77, 95% CI 0.62-0.96), while gastrointestinal risk (RR 1.51, 95% CI 0.97-2.33) and DAE-related colchicine discontinuation risk (RR 1.42, 95% CI 0.80-2.51) became non-significant. Colchicine provides lasting benefit for patients with cardiovascular and cerebrovascular diseases. Gastrointestinal risk is dose and time dependent, and higher early in treatment. Tolerating and maintaining long-term standard-dose therapy improves the benefit-risk balance. These findings highlight the early treatment phase as a period of higher gastrointestinal risk, suggesting that strategies to support adherence during this period warrant further investigation. PROSPERO registration number CRD42024623329.

Dilated cardiomyopathy (DCM) and left ventricular non-compaction (LVNC) are major non-ischemic cardiomyopathy (NICM) subtypes with heterogeneous outcomes. Conventional clinical and echocardiographic markers remain insufficient for long-term risk stratification. This study aimed to identify serum metabolites associated with adverse cardiovascular outcomes and evaluate their incremental prognostic value in NICM. Thirty-two patients with DCM or LVNC and left ventricular ejection fraction < 50% were enrolled and followed for a median of 45.5 months. The primary endpoint was a composite of cardiovascular death, heart failure-related hospitalization, or clinically indicated cardiovascular device implantation. Baseline serum samples underwent liquid chromatography-mass spectrometry-based untargeted metabolomic profiling. Differential metabolites were identified using OPLS-DA and KEGG enrichment analysis. Prognostic metabolites were screened using Cox regression, Kaplan-Meier analysis, correlation filtering, and ROC analysis. An integrated Cox model combining clinical and metabolic markers was evaluated using bootstrapping, calibration, and time-dependent ROC analysis. A total of 299 differential metabolites were identified and enriched in bile secretion, steroid hormone biosynthesis, and neuroactive ligand-receptor interaction pathways. Sphingosine-1-phosphate (S1P) and tetrahydrocortisone (THE) were selected as final prognostic metabolite biomarkers, with ROC AUCs of 0.777 and 0.793, respectively. The integrated model incorporating S1P, THE, tricuspid annular plane systolic excursion, and total protein achieved a bootstrap-corrected C-index of 0.772, with time-dependent AUCs of 0.92 and 0.86 at 3 and 5 years. Serum metabolomics may provide complementary prognostic information in NICM. S1P and THE are exploratory biomarkers linked to remodeling and stress, supporting risk stratification in NICM with reduced ejection fraction.

Heart failure accounts for more than one million US hospitalizations annually, with 30-day all-cause readmission approaching 25% and triggering CMS Hospital Readmissions Reduction Program penalties. The 2022 ACC/AHA/HFSA guideline and the 2023 ESC focused update elevated SGLT2 inhibitors to Class I therapy for heart failure with reduced ejection fraction (HFrEF) [1, 2]. The DAPA ACT HF-TIMI 68 prespecified meta-analysis demonstrated reductions in cardiovascular death or worsening heart failure (HR 0.71) and all-cause mortality (HR 0.57). Real-world prescribing patterns and 30-day readmission outcomes in the post-guideline US era are not well characterized. The relative contribution of clinical stability variables versus co-prescribed guideline-directed medical therapy (GDMT) to confounding has not been directly quantified in this setting. We conducted a retrospective cohort study at four NYU Langone Health hospitals from January 2023 to January 2026. Adults with a primary heart failure discharge diagnosis were included. The prespecified primary analysis was in the HFrEF subgroup (LVEF ≤ 40%). The primary outcome was 30-day all-cause readmission. Stabilized inverse probability of treatment weighting (IPTW) was the primary adjustment, with overlap weighting (ATO) as sensitivity analysis. Hierarchical logistic regression decomposed the confounding contribution of clinical stability parameters relative to GDMT. The E-value assessed robustness to unmeasured confounding. Among 438 patients, 122 (27.9%) received in-hospital SGLT2 inhibitor initiation. The HFrEF rate was 41.6%, a sixfold increase from 6.6% reported in INSIGHT-HF (2020-2021). Patients with prior heart failure hospitalization received SGLT2 inhibitors at 11.4% versus 29.7% in those without (p < 0.001). In HFrEF (n = 221), 30-day readmission was 12.1% versus 31.8% (crude OR 0.29, 95% CI 0.14-0.61). The primary IPTW estimate was OR 0.34 (95% CI 0.13-0.91, p = 0.032). Sensitivity analyses were directionally consistent. Clinical stability parameters contributed only 9.3% confounding attenuation; GDMT was the dominant confounder. In a contemporary US post-guideline cohort, in-hospital SGLT2 inhibitor initiation reached 41.6% in HFrEF but remained low in patients with recent heart failure hospitalization. In-hospital SGLT2 inhibitor initiation was associated with lower 30-day all-cause readmission, though initiation was strongly bundled with discharge GDMT optimization and cannot be distinguished from a GDMT optimization effect with this study design. These findings should be considered hypothesis-generating. Because short-term safety events and post-discharge persistence were not systematically captured, these findings should not be interpreted as establishing the benefit-risk profile of inpatient SGLT2 inhibitor initiation. The prescribing gap in high-risk patients is an actionable quality-improvement target.

Risk-Based Nurse-Managed Personalized Heart Failure Interventions: The ALLEVIATE-HF Trial.

The C-reactive protein-albumin-lymphocyte (CALLY) index is a composite biomarker integrating systemic inflammation (elevated C-reactive protein), nutritional status (decreased albumin), and immune function (reduced lymphocyte count). Its prognostic significance for mortality in the general population remains insufficiently characterized. We analyzed data from the National Health and Nutrition Examination Survey (NHANES, 1999-2010), comprising 11,797 adults (5,671 men [weighted 48.4%] and 6,126 women [weighted 51.6%]; median age, 45 years). The CALLY index was calculated for each participant. Associations between the CALLY index and all-cause and cardiovascular mortality were evaluated using Kaplan-Meier analysis (for descriptive visualization), weighted multivariable Cox proportional hazards regression, Fine-Gray competing risk models, and restricted cubic spline (RCS) regression. Predictive performance was assessed using time-dependent receiver operating characteristic (ROC) analysis. The incremental predictive value beyond established risk factors was quantified using the integrated discrimination improvement (IDI) and category-free net reclassification improvement (NRI). Compared with the lowest quartile, the highest CALLY quartile was associated with lower risks of all-cause mortality (multivariable-adjusted hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.51-0.74; P < 0.001) and cardiovascular mortality (HR, 0.51; 95% CI, 0.39-0.68; P < 0.001). In Fine-Gray competing risk models, the subdistribution hazard ratio for cardiovascular mortality was 0.55 (95% CI, 0.39-0.76; P < 0.001), with a lower cumulative incidence of cardiovascular death in quartile 4 versus quartile 1 (Gray's test, P < 0.001). RCS analyses revealed significant non-linear associations: an approximately L-shaped relationship for all-cause mortality and a monotonically decreasing non-linear pattern for cardiovascular mortality (both P for non-linearity < 0.001). The CALLY index provided modest incremental predictive value beyond established risk factors for all-cause mortality (IDI, 0.4%; P = 0.007), but individual-level risk reclassification was limited (continuous NRI, 2.7%; P = 0.272). Significant effect modification for all-cause mortality was observed only for alcohol use (P for interaction = 0.005). Higher CALLY index values were significantly associated with lower mortality risk. The CALLY index demonstrated a significant, independent, and non-linear inverse association with all-cause and cardiovascular mortality in US adults. Its standalone predictive discrimination was modest (time-dependent AUC < 0.70), but its integration into multivariable risk models provided modest yet statistically significant incremental prognostic information (IDI, 0.4%; P = 0.007). Individual-level risk reclassification was limited (continuous NRI, 2.7%; P = 0.272). These findings suggest that CALLY may serve as a complementary biomarker for risk stratification when integrated with conventional risk factors rather than as a standalone prediction tool.

Vagal Nerve Stimulation in Patients With Heart Failure and Reduced Ejection Fraction: The ANTHEM-HFrEF Trial.

Transthyretin amyloid cardiomyopathy (ATTR-CM) is characterized by extracellular deposition of misfolded transthyretin protein in the myocardium, leading to progressive dysfunction of both the left ventricle (LV) and left atrium (LA). While LV impairment has traditionally been emphasized in risk stratification, emerging evidence suggests that LA dysfunction may also contribute significantly to clinical outcomes. However, the prognostic implications of combining both LV and LA functional assessments in ATTR-CM remain unknown. We retrospectively evaluated 139 patients with ATTR-CM treated with disease-modifying therapies. LV and LA function were assessed using global longitudinal strain (GLS) and LA reservoir strain via speckle-tracking echocardiography. Patients were categorized into three groups based on median GLS (10.9%) and LA strain (9.5%): (1) preserved both LV and LA function, (2) impaired both, and (3) preserved only one. The primary endpoint was a composite of cardiovascular death or hospitalization for heart failure, with a median follow-up of 1.50years after treatment initiation. Patients with preserved function in both chambers experienced significantly fewer cardiovascular events, while those with impairment in both had the highest event rate. Patients with preserved function in only one chamber showed intermediate outcomes. In multivariable Cox regression analysis, combined LV and LA dysfunction was independently associated with adverse events (HR 8.89, 95% CI 2.38-44.20, P = 0.001). In conclusion, simultaneous evaluation of LV and LA function provides enhanced prognostic stratification in patients with ATTR-CM. This combined approach may support more accurate risk assessment and guide individualized therapeutic strategies in clinical practice.