The study by Elissamburu et al., recently published in Revista Argentina de Cardiología, provides relevant data on right ventricular (RV) function in patients with transthyretin cardiac amyloidosis (ATTR-CM). In a cohort of 154 patients, almost half presented with RV systolic dysfunction measured by TAPSE, which was independently associated with mortality, hospitalization for heart failure, and the onset of atrial fibrillation. (1)

This finding is important because care for cardiac amyloidosis has historically focused on the left ventricle, while the right ventricle has tended to be overlooked. However, in clinical practice, RV dysfunction has a decisive prognostic weight, not only in amyloidosis but also in most cases of heart failure, especially in those with preserved ejection fraction. (2,3) In this sense, the study reinforces a well-known concept: the evolution of patients with HF depends on both the right and left sides of the heart.

The practical relevance of this study lies in highlighting that a simple, accessible, and reproducible parameter such as TAPSE can be useful in risk stratification. Given the complexity of amyloidosis, which often requires sophisticated studies for diagnosis, the possibility of having a simple echocardiographic index available in any laboratory is a significant contribution. Systematically incorporating TAPSE measurement in patients with suspected or confirmed ATTR-CM can help identify higher-risk subgroups and guide specific decisions.

For example, a patient with reduced TAPSE could benefit from closer monitoring, a lower threshold for initiating anticoagulation upon the onset of atrial fibrillation, or earlier evaluation for specific therapies. In a clinical setting where access to disease-modifying drugs such as tafamidis remains limited, having parameters that allow for better selection of who to prioritize becomes particularly useful in real-world practice.

At the same time, we must not lose sight of a general consideration: when a new prognostic marker is proposed, its true value lies in demonstrating increased capacity over what we already know. If RV dysfunction appears almost inevitably in patients with advanced heart failure or in those with elevated NTproBNP and troponin, it is worth asking how much TAPSE adds beyond confirming an already evident risk. The study by Elissamburu et al. shows statistical independence, but future studies should demonstrate added value over models that integrate biomarkers and clinical variables.

In short, this work invites us to look at the right ventricle with the importance it deserves. It is not a secondary player, but a key piece in the evolution of ATTR-CM. But the message is broader: in all heart failure conditions, and particularly in those with preserved ejection fraction, RV function is a major determinant of outcome. Incorporating its routine assessment not only enriches our understanding of the disease, but can also translate into more timely and beneficial decisions for our patients. (4)