Minervini, AnnamariaBarge-Caballero, GonzaloLópez-López, AndreaLópez-López, ManuelGonzález-Babarro, EvaGómez-Otero, InésBilbao-Quesada, RaquelGutiérrez-Feijoo, MarioVarela-Román, AlfonsoBouzas-Mosquera, AlbertoCrespo-Leiro, María GenerosaBarge-Caballero, Eduardo2026-02-042026-02-042025-12-01Minervini A, Barge-Caballero G, López-López A, López-Pérez M, González-Babarro E, Gómez-Otero I, Bilbao-Quesada R, Gutiérrez-Feijoo M, Varela-Román A, Bouzas-Mosquera A, Crespo-Leiro MG, Barge-Caballero E. Transthyretin serum levels and clinical outcomes in patients with transthyretin amyloid cardiomyopathy. Eur J Intern Med. 2025 Dec;142:106350.0953-6205https://hdl.handle.net/2183/47224Multicenter study[Abstract] Purpose: To study the prognostic value of serum transthyretin levels in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Methods: We analysed the clinical information collected in a prospective registry of consecutive patients with ATTR-CM treated in 7 Spanish hospitals from January 1st, 2018 to October 31st, 2024. Baseline serum transthyretin was correlated by means of multivariable Cox´s regression with long-term clinical outcomes death from any cause and the combined endpoint death from any cause or heart failure (HF) hospitalization. Results: We studied 216 patients with ATTR-CM who were followed over a median period of 835 days. Baseline transthyretin serum levels correlated with older age and with several markers of more advanced cardiac disease, including higher NYHA class and UK-NAC stage, as well as with poorer nutritional status, according to CONUT score. Multivariable Cox´s regression revealed a statistically significant, independent association between increasing values of serum transthyretin and lower risk of death from any cause (adjusted HR per 1 mg/dl = 0.954; 95 % CI 0.921-0.989) and lower risk of the combined endpoint death from any cause or HF hospitalization (adjusted HR per 1 mg/dl = 0.967; 95 % CI 0.936-0.999). Serum transthyretin showed incremental predictive value for both study outcomes in addition to the UK-NAC staging system. Conclusions: Our study suggests that serum transthyretin is an independent prognostic factor in patients with ATTR-CM.engAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Cardiac amyloidosisOutcomesPrognosisSerum levelsTransthyretinjournal articleembargoed access10.1016/j.ejim.2025.05.015