uthor Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.
Alberto Aimo
Scuola Superiore Sant'Anna and Fondazione Toscana Gabriele Monasterio
Pisa, Italy

Main Body of the Abstract
Background: Transthyretin amyloid cardiomyopathy (ATTR-CA) is an important cause of heart failure (HF). The liver is the site of TTR production, but patients with ATTR-CA do not show clinical evidence of liver disease. We searched for evidence of liver involvement in ATTR-CA.
Methods: We analyzed ATTR-CA patients from 4 Italian centers, examining liver function through scintigraphy, cardiovascular magnetic resonance, and circulating biomarkers.
Results: Patients (n=528, 86% males, median age 81 years [interquartile range 76-84], 4% with TTR gene mutations) showed no liver uptake was observed at scintigraphy, while liver extracellular volume was expanded (median 0.69, clinically significant cut-off: 0.40). Gamma-glutamyltransferase (GGT) levels were 49 U/L (29-107), and higher than upper reference limits in 253 (48%). By comparison, patients displaying elevations in aspartate and alanine transaminases, total bilirubin, and alkaline phosphatase were 26%, 9%, 33%, and 1%, respectively. GGT levels in the highest tertile (≥82 U/L) correlated with indicators of more advanced cardiac disease, liver damage and venous congestion. After a 2.6-year median follow-up (interquartile range 1.4-3.9), 208 (39%) and 162 (33%) patients experienced all-cause mortality and heart failure (HF) hospitalization, respectively. GGT predicted all-cause mortality and HF hospitalization on top of the National Amyloidosis Centre score: hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.01-1.31, p=0.045, and HR 1.17, 95% CI 1.03-1.32, p=0.016, respectively.
Conclusions: GGT is often elevated in patients with ATTR-CA. GGT levels have a strong prognostic value, and refine risk prediction over the National Amyloidosis Centre score. GGT measurement may thus refine risk stratification and therapy decision-making.

**uthor Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Alberto Aimo
Scuola Superiore Sant'Anna and Fondazione Toscana Gabriele Monasterio
Pisa, Italy

**Main Body of the Abstract**
**Background:** Transthyretin amyloid cardiomyopathy (ATTR-CA) is an important cause of heart failure (HF). The liver is the site of TTR production, but patients with ATTR-CA do not show clinical evidence of liver disease. We searched for evidence of liver involvement in ATTR-CA.
**Methods:** We analyzed ATTR-CA patients from 4 Italian centers, examining liver function through scintigraphy, cardiovascular magnetic resonance, and circulating biomarkers.
**Results:** Patients (n=528, 86% males, median age 81 years [interquartile range 76-84], 4% with _TTR_ gene mutations) showed no liver uptake was observed at scintigraphy, while liver extracellular volume was expanded (median 0.69, clinically significant cut-off: 0.40). Gamma-glutamyltransferase (GGT) levels were 49 U/L (29-107), and higher than upper reference limits in 253 (48%). By comparison, patients displaying elevations in aspartate and alanine transaminases, total bilirubin, and alkaline phosphatase were 26%, 9%, 33%, and 1%, respectively. GGT levels in the highest tertile (≥82 U/L) correlated with indicators of more advanced cardiac disease, liver damage and venous congestion. After a 2.6-year median follow-up (interquartile range 1.4-3.9), 208 (39%) and 162 (33%) patients experienced all-cause mortality and heart failure (HF) hospitalization, respectively. GGT predicted all-cause mortality and HF hospitalization on top of the National Amyloidosis Centre score: hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.01-1.31, p=0.045, and HR 1.17, 95% CI 1.03-1.32, p=0.016, respectively.
**Conclusions:** GGT is often elevated in patients with ATTR-CA. GGT levels have a strong prognostic value, and refine risk prediction over the National Amyloidosis Centre score. GGT measurement may thus refine risk stratification and therapy decision-making.

Gamma-glutamyltransferase independently predicts all-cause mortality  in transthyretin cardiac amyloidosis PC60 (#247)

We invite you to attend the XIX International Symposium on Amyloidosis to be held in Rochester, MN.

This symposium is organized as a hybrid meeting (with the focus on in-person) held from Sunday, May 26 through Thursday, May 30, 2024.

Together with the ISA Board and members of Mayo Clinic, a very attractive scientific hybrid program is being planned. The program will cover a variety of types of systemic amyloidosis: ATTR (hereditary and wild-type), AL (light-chain), AA and less frequent forms. There will be key lectures, specific symposia including those company sponsored, oral presentations and poster sessions of accepted abstracts.

COURSE DESCRIPTION
This program will provide a comprehensive review of state-of-the-art education in systemic amyloidosis: basic science, pathophysiology, diagnosis, current and emerging treatments. Scientific presentations will include competitive oral and poster abstracts. The rapid evolution of scientific discovery and expanding treatment options has created tremendous interest in the field and this meeting will fill and important gap in educating scientists and clinicians.