Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, Trieste 34100, Italy; Cardiac Surgery, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), Trieste, Italy.
Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Via P. Valdoni 7, Trieste 34100, Italy.
Eur J Intern Med. 2024 Apr;122:68-77. doi: 10.1016/j.ejim.2023.09.026. Epub 2023 Oct 17.
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.
心电图（ECG）上 QRS 波电压与超声心动图（echo）上左心室（LV）壁厚度（LVWT）之间的不匹配是淀粉样心肌病（AC）的公认危险信号（RF），可以通过特定指标进行测量。目前尚未对头对头比较疑似 AC 的超声心动图患者中不同 ECG/echo 指标进行比较。本研究旨在评估不同 ECG/echo 指标在这组患者中的表现和额外的诊断价值。
对参与意大利前瞻性多中心研究 AC-TIVE 研究的 LV 肥厚、射血分数保留和≥1 个 AC 超声心动图 RF 的患者的 ECG 进行独立分析，由两名心脏病专家进行分析。评估低 QRS 电压和 8 种不同的 ECG/echo 指标。计算队列特异性截止值。
在 170 例患者中，55 例（32%）被诊断为 AC。低 QRS 电压合并室间隔≥1.6cm 是最特异的（特异性 100%，阳性预测值 100%）ECG/echo 指标，而所有 QRS 电压之和与 LVWT 的比值<7.8 是最敏感和准确的（敏感性 94%，阴性预测值 97%，准确性 82%）。当将后一指标添加到使用易于获得的临床变量的模型中时，AC 的诊断准确性大大提高（AUC 从 0.84 增加到 0.95；p=0.007）。
在非扩张性肥厚心室、射血分数正常且具有 AC 超声心动图 RF 的患者中，易于测量的 ECG/echo 指标，主要是当添加到少数临床变量时，可帮助医生指导进行二级检查。需要进行外部验证。
