Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariškių 2, LT-08661 Vilnius, Lithuania.
Center of Haematology, Oncology and Transfusion Medicine, Vilnius University Hospital Santaros Klinikos, Santariškių 2, LT-08661 Vilnius, Lithuania; Faculty of Medicine, Vilnius University, Čiurlionio 21/27, LT-03101 Vilnius, Lithuania.
J Electrocardiol. 2021 Sep-Oct;68:157-163. doi: 10.1016/j.jelectrocard.2021.08.011. Epub 2021 Aug 12.
ST/T abnormalities recognized as electrocardiographic (ECG) left ventricular (LV) strain pattern are known as a marker of myocyte death and reduced survival. The purpose of this study was to determine whether ECG LV strain pattern, its components and atrial fibrillation (AF) predict lower survival at the time of diagnosis of systemic light chain (AL) amyloidosis.
12‑lead surface electrocardiogram (ECG), standard two-dimensional echocardiography, laboratory analyses were retrospectively evaluated within 2 months of diagnosis in 87 patients with biopsy-proven systemic AL amyloidosis from 2009 to 2017 in a single center. ECG strain pattern was defined as coexistence of ST-segment horizontal or downward sloping depression ≥0.05 mV at its most horizontal section and negative asymmetrical T-wave deeper than 0.1 mV in at least 1 of leads I,aVL,V1-V6. Patients with QRS >120 ms (BBB or major IVCD) were excluded from the analysis.
Kaplan-Meier survival analysis revealed a 1.8-fold shorter overall survival (OS) at 2 years in the ECG strain (21% of participants) group (p = 0.0078), 2.0-fold shorter OS in the ST-segment depression (STd) (isolated and strain related as one group) (34% of participants) group (p < 0.0001), and 3.9-fold shorter OS in AF (23% of participants) group (p < 0.0001) compared with those without. Median survival of patients with STd and AF were and 13.0 (range 1-74) and 9.5 (range 1-74) months respectively. In univariate analysis STd and AF were stronger predictors of inferior OS than relative wall thickness, average E/e' ratio, and LV ejection fraction, but weaker predictors of OS than B-type natriuretic peptide. In multivariate analysis STd and AF lost significance after adjustment for age, gender, number of organs involved and BNP.
ST-segment depression and AF were not significantly associated with reduced survival in AL amyloidosis at diagnosis.
心电图（ECG）左心室（LV）应变模式中的 ST/T 异常被认为是心肌细胞死亡和存活率降低的标志物。本研究的目的是确定心电图 LV 应变模式及其成分和心房颤动（AF）是否可预测系统性轻链（AL）淀粉样变性诊断时的生存率降低。
在单中心回顾性评估了 2009 年至 2017 年间经活检证实的 87 例系统性 AL 淀粉样变性患者在诊断后 2 个月内的 12 导联体表心电图（ECG）、标准二维超声心动图和实验室分析。心电图应变模式定义为至少 1 个导联 I、aVL、V1-V6 中存在最水平段 ST 段水平或向下倾斜性压低≥0.05 mV 和至少 1 个导联中负性不对称 T 波深于 0.1 mV 的共存。排除 QRS>120 ms（BBB 或主要 IVCD）的患者进行分析。
Kaplan-Meier 生存分析显示，在心电图应变（21%的参与者）组中，2 年总生存率（OS）缩短了 1.8 倍（p=0.0078），ST 段压低（孤立和应变相关作为一组）（34%的参与者）组中，OS 缩短了 2.0 倍（p<0.0001），AF（23%的参与者）组中，OS 缩短了 3.9 倍（p<0.0001）。STd 和 AF 患者的中位生存时间分别为 13.0（范围 1-74）和 9.5（范围 1-74）个月。在单因素分析中，STd 和 AF 是 OS 降低的更强预测因子，优于相对壁厚度、平均 E/e' 比值和 LV 射血分数，但弱于 B 型利钠肽。在多因素分析中，在调整年龄、性别、受累器官数量和 BNP 后，STd 和 AF 失去了意义。
ST 段压低和 AF 在 AL 淀粉样变性诊断时与生存率降低无显著相关性。
