Background Transthyretin Amyloid Cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. Given the expansion of non-invasive diagnosis with 99mTc-pyrophosphate [99mTc-PYP] scanning, and clinical use of the transthyretin stabilizer, Tafamadis, we sought to examine the interplay of planar imaging heart-to-contralateral (H/CL) ratio, cardiac biomarkers, and survival probability in a contemporary cohort of patients referred for non-invasive evaluation of ATTR-CM. Methods Single-Center retrospective cohort study of 351 consecutive patients who underwent a standardized imaging protocol with 99mTc-PYP scanning for the evaluation of ATTR-CM between January 1st 2018 to October 31th 2019. After the exclusion of light chain amyloidosis, patients were characterized as scan consistent with ATTR (+ATTR-CM) or scan not consistent with ATTR (-ATTR-CM) using current guidelines. Linear regression was used to examine the relationship between biomarkers and H/CL and univariate Cox proportional hazards models were used to assess probability of transplant free survival. Results 318 patients were included in the analysis (n=86 patients +ATTR-CM; n= 232 patients -ATTR-CM). Median time of follow-up 20.1 months. 67% of +ATTR-CM received Tafamadis during the study period (median treatment duration 17 months). Median H/CL ratio was 1.56 [1.40, 1.75]). H/CL ratio above or below 1.6 did not appear to have an impact on survival probability in +ATTR-CM patients (p = 0.30; HR, 0.65[95% CI, 0.31–1.41, FIG 1A] nor in the entire cohort referred for scanning (p = 0.90; HR, 0.97 [95% CI, 0.50-1.89]). Cardiac Biomarkers were poorly correlated with H/CL (Troponin T - Multiple-R2 = 0.024; NT-proBNP - Multiple-R2 =0.023, FIG 1B). The Gillmore staging system predicted survival probability in +ATTR-CM as well as in the entire cohort referred for scanning. There was a trend toward longer survival among those who were -ATTR-CM compared to +ATTR-CM (p= 0.051; HR .64 [95% CI, 0.40-1.00]). Conclusions At a large referral center, the intensity of 99mTc-PYP uptake (H/CL ratio) has neither correlation with cardiac biomarker concentrations nor prognostic utility in an analysis of “intermediate term” outcomes in the early therapeutics era. The Gillmore staging scheme remains predictive of survival in this contemporary cohort. Transthyretin Amyloid Cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. Given the expansion of non-invasive diagnosis with 99mTc-pyrophosphate [99mTc-PYP] scanning, and clinical use of the transthyretin stabilizer, Tafamadis, we sought to examine the interplay of planar imaging heart-to-contralateral (H/CL) ratio, cardiac biomarkers, and survival probability in a contemporary cohort of patients referred for non-invasive evaluation of ATTR-CM. Single-Center retrospective cohort study of 351 consecutive patients who underwent a standardized imaging protocol with 99mTc-PYP scanning for the evaluation of ATTR-CM between January 1st 2018 to October 31th 2019. After the exclusion of light chain amyloidosis, patients were characterized as scan consistent with ATTR (+ATTR-CM) or scan not consistent with ATTR (-ATTR-CM) using current guidelines. Linear regression was used to examine the relationship between biomarkers and H/CL and univariate Cox proportional hazards models were used to assess probability of transplant free survival. 318 patients were included in the analysis (n=86 patients +ATTR-CM; n= 232 patients -ATTR-CM). Median time of follow-up 20.1 months. 67% of +ATTR-CM received Tafamadis during the study period (median treatment duration 17 months). Median H/CL ratio was 1.56 [1.40, 1.75]). H/CL ratio above or below 1.6 did not appear to have an impact on survival probability in +ATTR-CM patients (p = 0.30; HR, 0.65[95% CI, 0.31–1.41, FIG 1A] nor in the entire cohort referred for scanning (p = 0.90; HR, 0.97 [95% CI, 0.50-1.89]). Cardiac Biomarkers were poorly correlated with H/CL (Troponin T - Multiple-R2 = 0.024; NT-proBNP - Multiple-R2 =0.023, FIG 1B). The Gillmore staging system predicted survival probability in +ATTR-CM as well as in the entire cohort referred for scanning. There was a trend toward longer survival among those who were -ATTR-CM compared to +ATTR-CM (p= 0.051; HR .64 [95% CI, 0.40-1.00]). At a large referral center, the intensity of 99mTc-PYP uptake (H/CL ratio) has neither correlation with cardiac biomarker concentrations nor prognostic utility in an analysis of “intermediate term” outcomes in the early therapeutics era. The Gillmore staging scheme remains predictive of survival in this contemporary cohort.