ABC Imagem Cardiovasc. 2026; 39(3): e20260102

The Extracellular Matrix Speaks. But Are We Truly Listening? Left Atrial Strain, Hereditary Transthyretin Amyloidosis, and Some Reflections

Tonnison de Oliveira

Silva

, Luiz Eduardo Fonteles

Ritt

DOI: 10.36660/abcimg.20260102i

This Short Editorial is referred by the Research article "Left Atrial Strain Assessment in Hereditary Amyloidosis: A Systematic Review".

Left atrial strain, especially left atrial reservoir strain (LASr), is an important tool in the assessment of atrial function and diastology. It changes before remodeling becomes detectable on echocardiography and contributes to a better understanding and characterization of diastolic dysfunction and left atrial–left ventricle (LA–LV) uncoupling.^– In patients with preserved ejection fraction, LASr values <18% strongly suggest elevated filling pressures.^,

In amyloid cardiomyopathy, the mean values of the atrial strain components are characteristically very reduced compared with individuals without the disease, and may serve as relevant clinical clues for diagnosis.^, Atrial dysfunction in amyloid cardiomyopathy results from two main mechanisms: direct infiltration of amyloid fibrils into the atrial wall, and chronic elevation of left ventricular filling pressures. Characteristically, the atrial wall is thin and highly dependent on the integrity of the extracellular matrix; therefore, even small deposits of amyloid fibrils can reduce reservoir strain, before increases in atrial volume or diameter occur.

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