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Aim: to assess the prognostic impact of follow-up echo-Doppler assessment in cardiac amyloidosis.Methods and Results: we retrospectively evaluated a series of 25 patients (69% males, mean age 63±12 years) with a bioptic diagnosis of systemic amyloidosis and cardiac involvement (documented at echocardiography). All patients were studied by echo-Doppler both at diagnosis and after a mean follow-up of 17.4±19.8 months. At diagnosis, the mean IV septum thickness was 16 ± 4 mm, and 31% presented a restrictive filling pattern (RFP) at Doppler evaluation. Two follow-up echo-Doppler variables were selected as prognostically useful: 1) concentric reverse remodelling (CRR) defined as a decrease of interventricular septal thickness ≥ 2 mm. 2) persistence or development of RFP. At follow-up echocardiogram 6 patients (24%) showed CRR, 4 patients (16%) developed a RFP and 7 patients (28%) maintained a RFP. During a mean follow-up of 24±22 months 16 patients (64%) died; survival rates were 83% vs 29% in patients with CRR with respect to remaining patients (p=0.019). In addition, survival rates were significantly lower in patients in whom RFP persisted or developed, with respect to those without RFP during follow-up (14% vs 25% vs 57%, respectively: p=0.017).Conclusions: The prognosis of cardiac amyloidosis is confirmed as severe in the short time. The absence of CRR and persistence or development of RFP during follow-up emerged as markers of worse prognosis in the mid-term. In cardiac amyloidosis echocardiography has not only a diagnostic role at initial evaluation, but also an important prognostic role during follow-up.