Abstract
Early non-invasive identification of cardiac amyloidosis (CA) is of growing clinical importance. Low voltage on electrocardiogram (ECG), increased left ventricular (LV) septal thickness (ST) and global longitudinal strain (GLS) on echocardiography, and elevated brain natriuretic peptides (BNP) are used as surrogates of CA. Thirty-five patients (50 ± 14 years, 22 females) underwent an ECG to analyze low-voltage QRS ( 14 mm, E/E’ >6.6, GLS 129 pg/ml, and an overall abnormal ECG showed good capability to distinguish patients with and without CA. All these parameters were predictors of CA in univariate analysis while low-voltage QRS showed the worst performance. LVST >14 mm (p = 0.002) was the best independent predictor of CA, achieving sensitivity of 78% and accuracy of 89%. However, a LVST >14 mm (p = 0.005) plus an abnormal ECG (p = 0.03) show together a higher sensitivity, equal to 89%, in identifying CA. An integrated evaluation of ECG and echocardiography is a sensitive and low-cost technical approach to identify CA in patients with transthyretin gene mutation.
Highlights
Non-invasive identification of cardiac amyloidosis (CA) is of growing clinical importance
All participants had brain natriuretic peptides (BNP) blood testing. 99mTc-DPD scintigraphy assumed as a reference method showed CA in 18 patients (51%, CA group) and no accumulation in 17 patients
LVST >14 mm (p = 0.002) was the best independent predictor of CA, achieving sensitivity of 78% and accuracy of 89%
Summary
Non-invasive identification of cardiac amyloidosis (CA) is of growing clinical importance. Usefulness of combining electrocardiogram and echocardiography findings and brain natriuretic peptide in early detection of cardiac amyloidosis in subjects with transthyretin gene mutation Gianluca Di Bella1*, Fabio Minutoli2, Anna Mazzeo3, Matteo Cssale1, Claudia Stancanelli3, Scipione Carerj1, Sergio Baldari2, Giuseppe Vita3 From First European Congress on Hereditary ATTR amyloidosis Paris, France.
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