Clinical correlates and prognostic values of pseudoinfarction in cardiac light-chain amyloidosis

Zhao, Lei; Li, Jian; Tian, Zhuang; Fang, Quan

doi:10.1016/j.jjcc.2015.11.004

Cited by 28 publications

(17 citation statements)

References 24 publications

(22 reference statements)

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“…In patients with cardiac amyloidosis, low voltage in limb leads, poor R progression, and pseudoinfarction were the most common findings 14‐16 . Low voltage QRS, pseudoinfarction and fragmented QRS was associated with adverse outcomes in cardiac amyloidosis defined by either endomyocardial biopsy or echocardiographic evidence 14,17,18 . However, in our study, the prevalence of low voltage in limb leads was far below that in other studies and did not correlate with poor prognosis.…”

Section: Discussioncontrasting

confidence: 72%

Electrocardiographic parameters and prognosis of renal light chain amyloidosis

Wang

Lan

et al. 2020

Clinical Cardiology

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Background: Cardiac involvement frequently occurs in patients with renal light chain (AL) amyloidosis, which predisposes these patients to heart failure, arrhythmia, or infarction with poor prognosis. Hypothesis: Twelve-lead electrocardiogram (ECG) parameters may be associated with prognosis in renal AL amyloidosis. Methods: A retrospective single-center cohort study was performed. Biopsy-proven renal AL amyloidosis patients from January 2014 to December 2018 at the First Affiliated Hospital of Xi'an Jiaotong University were enrolled. The baseline demographic information, laboratory tests, 12-lead ECG parameters at the time of diagnosis were obtained from medical records. The endpoint was defined as the time to all-cause death from baseline for all deceased patients and time to censor date (June 2019) for all other patients. Univariate and multivariate Cox proportional hazard models were conducted to identify the relationship between ECG parameters and all-cause mortality. Results: A total of 69 patients with a mean age of 61.5 ± 11.4 years were enrolled in this study. The median PR interval and QTc interval were 160 (140, 186) and 417 ± 42 ms. The mean follow-up duration was 15.9 ± 13.8 months. Multivariate Cox regression analysis showed that regardless of adjustment for age, gender and serum creatinine, PR interval (HR 1.022, 95% CI: 1.007-1.038, P = .005), and QTc interval (HR 1.012, 95% CI: 1.004-1.021, P = .004) were independently associated with all-cause mortality. Conclusions: PR interval and QTc interval were independently associated with allcause mortality in renal AL amyloidosis patients. ECG parameters may provide prognostic potential of renal AL amyloidosis patients and promote the management of patients with renal AL amyloidosis.

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Section: Discussioncontrasting

confidence: 72%

Electrocardiographic parameters and prognosis of renal light chain amyloidosis

Wang

Lan

et al. 2020

Clinical Cardiology

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“…In our study, we included only patients with cardiac AL amyloidosis confirmed by endocardial biopsy, a confirmatory diagnostic method, and there were some patients with equivocal echocardiographic findings even with positive endocardial biopsy. Previous studies have suggested that the presence of pseudoinfarction and fragmented QRS is associated with prognosis in cardiac AL amyloidosis defined by either endomyocardial biopsy or echocardiographic evidence in systemic amyloidosis 9,10 . However, neither pseudoinfarction nor fragmented QRS showed prognostic value in our study.…”

Section: Discussionmentioning

confidence: 98%

Associations of Electrocardiographic Parameters with Left Ventricular Longitudinal Strain and Prognosis in Cardiac Light Chain Amyloidosis

Kim

Lee

Choi

et al. 2019

Sci Rep

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A 12-lead ECG is a simple and less costly measure to assess cardiac amyloidosis and may reflect the infiltrative nature of cardiac amyloidosis and have prognostic value for predicting overall survival in patients with cardiac AL amyloidosis. Therefore, we investigated the associations of surface ECG parameters with left ventricular (LV) global longitudinal strain (GLS) and prognosis in patients with cardiac AL amyloidosis. We performed a multi-center, retrospective analysis of 102 biopsy-proven cardiac AL amyloidosis patients. Baseline studies included 12-lead surface ECG and echocardiography, with two-dimensional strain analysis performed within one month of diagnosis. From the Kaplan-Meier survival analysis, patients with prolonged QTc (≥483 msec) had significantly poorer survival. ECG scores were assigned according to presence of prolonged QTc (≥483 msec) and abnormal QRS axis, and the study participants were divided into three groups according to ECG score. Mean absolute value of LV GLS and regional LV longitudinal strain (LS) differed significantly among the three groups and decreased in a stepwise manner as ECG score increased. Log NT-proBNP increased in a stepwise manner as ECG score increased. Prolonged QTc (≥483 msec) and abnormal QRS axis showed significant incremental values in addition to the revised Mayo stage. The presence of prolonged QTc (≥483 msec) and abnormal QRS axis showed significant incremental values for overall mortality rates. In addition, ECG scores consisting of presence of prolonged QTc (≥483 msec), and abnormal QRS axis showed good association with longitudinal LV dysfunction and NT-proBNP. ECG finding may provide prognostic additional information regarding prognosis of AL amyloidosis with cardiac involvement.

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“…It has been reported that among patients with AL cardiac amyloidosis, low QRS voltage can be detected in 23-64% of patients 5-7 , while the pseudo-MI pattern can be detected in 15-69% 5, 8 . Furthermore, both low QRS voltages 5, 8 and pseudo-MI patterns 15,16 have been reported to be predictive of a poor prognosis in cardiac amyloidosis.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Electrocardiographic Follow-Up of a Patient with Light-Chain Cardiac Amyloidosis

et al. 2022

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Amyloid light-chain (AL) cardiac amyloidosis is known to result in restrictive cardiomyopathy, which has a poor prognosis. Although electrocardiography (ECG) is useful for its diagnosis and management, there are few reports on the long-term follow-up of electrocardiographic changes. The patient in the present case was a 62-year-old woman who visited our hospital due to palpitation and lower leg edema. A chest radiograph showed cardiac enlargement, and ECG revealed sinus rhythm, first-degree atrioventricular block, low QRS voltage in the limb leads and a pseudomyocardial infarction pattern in the precordial leads. Echocardiography revealed left ventricular hypertrophy with systolic and diastolic dysfunction. Immunoelectrophoresis demonstrated M-protein (IgGλ), and bone marrow biopsy implied IgGλ-type plasmacytoma. Myocardial biopsy findings were compatible with cardiac amyloidosis. Based on these findings, we diagnosed the patient with AL cardiac amyloidosis. Melphalan-prednisolone (MP) therapy was performed in conjunction with treatment for non-sustained ventricular tachycardia and congestive heart failure. Two years and four months later, the 4 sinus rhythm converted to atrial tachycardia. At a follow-up examination at four years and eight months, right branch block appeared. Then degree of intraventricular conduction was worsened, and the low voltage of the limb leads was not observed. Seven years after the diagnosis, she was eventually hospitalized for the treatment of pneumonia and heart failure with tachycardia. On the seventh day of hospitalization, heart rhythm was changed to atrial standstill with escaped ventricular rhythm and died of cardiac arrest. These ECG changes may provide valuable information regarding the pathophysiological changes that occur in AL cardiac amyloidosis.

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Clinical correlates and prognostic values of pseudoinfarction in cardiac light-chain amyloidosis

Abstract: The presence of pseudoinfarction on the ECG has a negative prognostic effect on AL patients with cardiac involvement.

Cited by 28 publications

References 24 publications

Electrocardiographic parameters and prognosis of renal light chain amyloidosis

Electrocardiographic parameters and prognosis of renal light chain amyloidosis

Associations of Electrocardiographic Parameters with Left Ventricular Longitudinal Strain and Prognosis in Cardiac Light Chain Amyloidosis

Long-Term Electrocardiographic Follow-Up of a Patient with Light-Chain Cardiac Amyloidosis

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