ECG/echo indexes in the diagnostic approach to amyloid cardiomyopathy: A head-to-head comparison from the AC-TIVE study.
Amyloid cardiomyopathy
ECG/echo indexes
Echocardiography
Electrocardiogram
Left ventricular mass
Light chain amyloidosis
Red flags
Transthyretin amyloidosis
Voltages
Journal
European journal of internal medicine
ISSN: 1879-0828
Titre abrégé: Eur J Intern Med
Pays: Netherlands
ID NLM: 9003220
Informations de publication
Date de publication:
17 Oct 2023
17 Oct 2023
Historique:
received:
03
08
2023
revised:
22
09
2023
accepted:
25
09
2023
medline:
20
10
2023
pubmed:
20
10
2023
entrez:
20
10
2023
Statut:
aheadofprint
Résumé
The discordance between QRS voltages on electrocardiogram (ECG) and left ventricle (LV) wall thickness (LVWT) on echocardiogram (echo) is a recognized red flag (RF) of amyloid cardiomyopathy (AC) and can be measured by specific indexes. No head-to-head comparison of different ECG/echo indexes among subjects with echocardiographic suspicion of AC has yet been undertaken. The study aimed at evaluating the performance and the incremental diagnostic value of different ECG/echo indexes in this subset of patients. Electrocardiograms of subjects with LV hypertrophy, preserved ejection fraction and ≥ 1 echocardiographic RF of AC participating in the AC-TIVE study, an Italian prospective multicenter study, were independently analyzed by two cardiologists. Low QRS voltages and 8 different ECG/echo indexes were evaluated. Cohort specific cut-offs were computed. Among 170 patients, 55 (32 %) were diagnosed with AC. Combination of low QRS voltages with interventricular septum ≥ 1,6 cm was the most specific (specificity 100 %, positive predictive value 100 %) ECG/echo index, while the ratio between the sum of all QRS voltages and LVWT <7,8 was the most sensitive and accurate (sensitivity 94 %, negative predictive value 97 %, accuracy 82 %). When the latter index was added to a model using easily-accessible clinical variables, the diagnostic accuracy for AC greatly increased (AUC from 0,84 to 0,95; p = 0,007). Among patients with non-dilated hypertrophic ventricles with normal ejection fraction and echocardiographic RF of AC, easily-measurable ECG/echo indexes, mainly when added to few clinical variables, can help the physician orient second level investigations. External validation of the results is warranted.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
The discordance between QRS voltages on electrocardiogram (ECG) and left ventricle (LV) wall thickness (LVWT) on echocardiogram (echo) is a recognized red flag (RF) of amyloid cardiomyopathy (AC) and can be measured by specific indexes. No head-to-head comparison of different ECG/echo indexes among subjects with echocardiographic suspicion of AC has yet been undertaken. The study aimed at evaluating the performance and the incremental diagnostic value of different ECG/echo indexes in this subset of patients.
METHODS
METHODS
Electrocardiograms of subjects with LV hypertrophy, preserved ejection fraction and ≥ 1 echocardiographic RF of AC participating in the AC-TIVE study, an Italian prospective multicenter study, were independently analyzed by two cardiologists. Low QRS voltages and 8 different ECG/echo indexes were evaluated. Cohort specific cut-offs were computed.
RESULTS
RESULTS
Among 170 patients, 55 (32 %) were diagnosed with AC. Combination of low QRS voltages with interventricular septum ≥ 1,6 cm was the most specific (specificity 100 %, positive predictive value 100 %) ECG/echo index, while the ratio between the sum of all QRS voltages and LVWT <7,8 was the most sensitive and accurate (sensitivity 94 %, negative predictive value 97 %, accuracy 82 %). When the latter index was added to a model using easily-accessible clinical variables, the diagnostic accuracy for AC greatly increased (AUC from 0,84 to 0,95; p = 0,007).
CONCLUSIONS
CONCLUSIONS
Among patients with non-dilated hypertrophic ventricles with normal ejection fraction and echocardiographic RF of AC, easily-measurable ECG/echo indexes, mainly when added to few clinical variables, can help the physician orient second level investigations. External validation of the results is warranted.
Identifiants
pubmed: 37858441
pii: S0953-6205(23)00346-1
doi: 10.1016/j.ejim.2023.09.026
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Francesca Longo
(F)
Maddalena Rossi
(M)
Guerino Giuseppe Varrà
(GG)
Riccardo Saro
(R)
Franca Dore
(F)
Francesca Girardi
(F)
Giuseppe Vergaro
(G)
Beatrice Musumeci
(B)
Camillo Autore
(C)
Francesco Cappelli
(F)
Federico Perfetto
(F)
Iacopo Olivotto
(I)
Stefano Favale
(S)
Maria Cristina Carella
(MC)
Andrea Igoren Guaricci
(AI)
Marco Matteo Ciccone
(MM)
Gianluca Di Bella
(G)
Daniela Tomasoni
(D)
Valeria Rella
(V)
Giovanna Branzi
(G)
Luigi Badano
(L)
Gianfranco Parati
(G)
Giuseppe Palmiero
(G)
Martina Caiazza
(M)
Angelo Giuseppe Caponetti
(AG)
Giulia Saturi
(G)
Marianna Eleonora Labate
(ME)
Alessandro Andreis
(A)
Elena Paneva
(E)
Gaetano Maria De Ferrari
(GM)
Luca Di Ienno
(L)
Giuseppe De Carli
(G)
Elisa Giacomin
(E)
Chiara Arzilli
(C)
Informations de copyright
Copyright © 2023. Published by Elsevier B.V.
Déclaration de conflit d'intérêts
Declaration of Competing Interest No conflicts of interest to declare for any Author in relation to the submitted work.