Cheng Zhongwei, Zhu Kongbo, Tian Zhuang, Zhao Dachun, Cui Quancai, Fang Quan
Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Ann Noninvasive Electrocardiol. 2013 Mar;18(2):157-62. doi: 10.1111/anec.12018. Epub 2012 Nov 22.
The electrocardiography (ECG) was the simplest and common adjunctive diagnostic tool for cardiac amyloidosis (CA). We sought to clarify the findings of ECG in patients with CA in order to early identification of CA according to the findings of ECG.
A total of 276 patients with diagnosis of systemic amyloidosis admitted to Peking Union Medical College Hospital from January 2000 to December 2011, were enrolled. Two groups were classified according to the cardiac involvement or not, namely CA (n = 189) and control (n = 87) groups. The low voltage on limb leads defined by the amplitude of the QRS complex in each limb leads ≤0.5 mV. The pseudo-infarct pattern defined by the presence of pathologic Q waves on at least two contiguous leads on ECG without obstructive coronary artery disease.
The mean age was 55 ± 12 (15-88) years, 168 patients (61%) were male. Atrial arrhythmia (15.9% vs 3.4%, P = 0.003), low voltage on limb leads (54.5% vs 20.7%, P < 0.001), atrioventricular block (14.8% vs 1.1%, P = 0.001) and pseudo-infarct pattern (40.2% vs 4.6%, P < 0.001) were more prevalent in CA than control groups. The combination of low voltage on limb leads and pseudo-infarct pattern was more common (28.0% vs 2.3%, P < 0.001) in CA than control groups. The sensitivity, specificity, positive and negative predictive values of the presence of low voltage on limb leads and pseudo-infarct pattern for the diagnosis of CA were 28%, 98%, 96%, and 39%, respectively.
In CA patients, low voltage on limb leads and pseudo-infarct pattern were the most common ECG findings. Atrial arrhythmia and atrioventricular block were the most common arrhythmias in CA patients. The combination of low voltage on limb leads and pseudo-infarct pattern had high specificity and positive predictive value for the diagnosis of CA.
心电图（ECG）是心脏淀粉样变性（CA）最简单且常用的辅助诊断工具。我们试图阐明CA患者的心电图表现，以便根据心电图结果早期识别CA。
纳入2000年1月至2011年12月在北京协和医院确诊为系统性淀粉样变性的276例患者。根据是否有心脏受累分为两组，即CA组（n = 189）和对照组（n = 87）。肢体导联低电压定义为各肢体导联QRS波群振幅≤0.5 mV。伪梗死图形定义为心电图上至少两个相邻导联出现病理性Q波且无阻塞性冠状动脉疾病。
平均年龄为55±12（15 - 88）岁，168例患者（61%）为男性。CA组房性心律失常（15.9% 对3.4%，P = 0.003）、肢体导联低电压（54.5% 对20.7%，P < 0.001）、房室传导阻滞（14.8% 对1.1%，P = 0.001）和伪梗死图形（40.2% 对4.6%，P < 0.001）比对照组更常见。CA组肢体导联低电压和伪梗死图形同时出现的情况比对照组更常见（28.0% 对2.3%，P < 0.001）。肢体导联低电压和伪梗死图形对CA诊断的敏感性、特异性、阳性预测值和阴性预测值分别为28%、98%、96%和39%。
在CA患者中，肢体导联低电压和伪梗死图形是最常见的心电图表现。房性心律失常和房室传导阻滞是CA患者最常见的心律失常。肢体导联低电压和伪梗死图形同时出现对CA诊断具有较高的特异性和阳性预测值。
