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Jan Wigand Eckstein, Hermann Körperich, Elena Weise Valdés, Vanessa Sciacca, Lech Paluszkiewicz, Wolfgang Burchert, Martin Farr, Philipp Sommer, Christian Sohns, Misagh Piran

• \(\it Background:\) Right ventricular (RV) strain has provided valuable prognostic information for patients with \(\underline {cardiac amyloidosis}\) (CA). However, the extent to which RV strain and strain rate can differentiate CA is not yet clinically established. CA underdiagnosis delays treatment strategies and exacerbates patient prognosis. \(\it Aims:\) Evaluation of \(\underline {cardiac magnetic resonance}\) (CMR) quantified RV global and regional strain of CA and \(\underline {HCM}\) patients along with CA subtypes. \(\it Methods:\) CMR feature tracking attained longitudinal, radial and circumferential global and regional strain in 47 control subjects (CTRL), 43 CA-, 20 hypertrophic cardiomyopathy- (HCM) patients. CA patients were subdivided in 21 transthyretin-related amyloidosis (ATTR) and 20 acquired immunoglobulin light chain (AL) patients. Strain data and baseline clinical parameters were statistically analysed with respect to \(\underline {diagnostic performance}\) and discriminatory power between the different clinical entities. \(\it Results:\) Effective differentiation of CA from HCM patients was achieved utilizing global longitudinal (GLS: 16.5 \(\pm\) 3.9% vs. −21.3 \(\pm\) 6.7%, p = 0.032), radial (GRS: 11.7 \(\pm\) 5.3% vs. 16.5 \(\pm\) 7.1%, p < 0.001) and circumferential (GCS: -7.6 \(\pm\) 4.0% vs. −9.4 \(\pm\) 4.4%, p = 0.015) right ventricular strain. Highest strain-based hypertrophic phenotype differentiation was attained using GRS (AUC = 0.86). Binomial regression found right \(\underline {ventricular ejection fraction}\) (RV-EF) (p = 0.017) to be a significant predictor of CA-HCM differentiation. CA subtypes had comparable cardiac strains. \(\it Conclusion:\) CMR-derived RV global strains and various regional longitudinal strains provide discriminative radiological features for CA-HCM differentiation. However, in terms of feasibility, cine-derived RV-EF quantification may suffice for efficient differential diagnostic support.