120 - Prognostic Value of Electrocardiographic Parameters and Longitudinal Strain in Cardiac Amyloidosis

Abstract

Background: Abnormal electrocardiographic findings in cardiac amyloidosis were suggested that they could predict mortality. Also longitudinal strain was a strong prognostic factor in comparison with any other echocardiographic parameter. The aim of the present study was to confirm a prognostic value of abnormal electrocardiographic findings and longitudinal strain. Methods: A total 32 patients with cardiac amyloidosis and mean left ventricular wall thickness ≤14 mm were enrolled retrospectively. A longitudinal strain was measured by 2-D speckle tracking technique in basal and global segment. A standard 12-lead electrocardiography was reviewed to find abnormal findings. Patients were divided into two groups according to the presence of all-cause mortality (n = 20), or the absence of all-cause mortality (n = 12). All electrocardiographic abnormalities and longitudinal strain were analyzed and the relationship between abnormal electrocardiographic findings and longitudinal strain also confirmed. We invented the ECG Scoring System additionally to predict mortality. Results: The prevalence of abnormal electrocardiographic findings was similar to results of previous studies, except for interventricular conduction delay. All abnormal electrographic findings were not associated with adverse outcomes directly. Patients with all-cause mortality reported higher N-terminal pro-brain natriuretic peptide levels (16286 pg/ml vs 6174 pg/ml, P < .002), lower average basal longitudinal strain (5.8 vs 9.1, P < .008) and lower global longitudinal strain (8.6 vs 11.2, P < .009). Multivariate Cox analysis showed that the average basal longitudinal strain and NT pro-BNP levels were the only independent predictor of all-cause mortality. Among abnormal electrocardiographic findings, low voltage in limb leads, pseudo-infarction, right and/or extreme axis deviation of QRS axis, and Total ECG Score (The sum of ECG score) were related with poor longitudinal strain values. Conclusion: The average basal longitudinal strain was an independent prognostic factor in cardiac amyloidosis. Low voltage in limb lead, pseudo-infarction, and Total ECG Score has the possibility of predicting poor outcomes in cardiac amyloidosis but, need larger study to prove it.View Large Image Figure ViewerDownload Hi-res image Download (PPT)