Utility of Combined Indexes of Electrocardiography and Echocardiography in the Diagnosis of Biopsy Proven Primary Cardiac Amyloidosis

Cheng, Zhongwei; Kang, Li‐Wei; Tian, Zhuang; Chen, Weiyun; Guo, Wenjuan; Xu, Jia; Chen, Taibo; Fang, Ligang; Zeng, Yong; Cheng, Ke-Di; Fang, Quan

doi:10.1111/j.1542-474x.2010.00403.x

Cited by 31 publications

(26 citation statements)

References 12 publications

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“…The low voltage on limb leads was the most common finding, followed by pseudo-infarct pattern and atrioventricular block. Cheng et al 11 studied the ECG and ECHO features of 11 patients with biopsy-proven CA, concluded the ratio of R(I) / LVPW < 0.4 for the diagnosis of CA had the sensitivity of 91% and specificity of 100%, the positive and negative predictive values of 100% and 91%, respectively; the ratios of R(V5/6) /LVPW < 0.7 had the sensitivity of 91% and specificity of 89%, the positive and negative predictive values of 91% and 89%, respectively. Atrial arrhythmia was very common in CA patients.…”

Section: Discussionmentioning

confidence: 99%

“…The results of the present study were similar with previous reports. [8][9][10][11] Murtagh et al 8 from the Mayo Clinic reported that 127 patients with biopsy-proven primary CA and found that the low voltage was present in 46% of patients and a pseudo-infarct pattern was present in 47% of patients. The pseudo-infarct patterns were anterior (36%), inferior (12%), and lateral (14%).…”

Section: Discussionmentioning

confidence: 99%

“…Rahman et al 9 reported that the low voltage on limb leads associated with IVS thickness > 1.98 cm, the diagnosis of CA could be made with a sensitivity of 72% and a specificity of 91%, the positive and negative predictive values were 79% and 88%, respectively. Cheng et al 11 studied the ECG and ECHO features of 11 patients with biopsy-proven CA, concluded the ratio of R(I) / LVPW < 0.4 for the diagnosis of CA had the sensitivity of 91% and specificity of 100%, the positive and negative predictive values of 100% and 91%, respectively; the ratios of R(V5/6) /LVPW < 0.7 had the sensitivity of 91% and specificity of 89%, the positive and negative predictive values of 91% and 89%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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The Findings of Electrocardiography in Patients with Cardiac Amyloidosis

Cheng

Zhu

Tian

et al. 2012

Noninvasive Electrocardiol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Findings of Electrocardiography in Patients with Cardiac Amyloidosis

Cheng

Zhu

Tian

et al. 2012

Noninvasive Electrocardiol

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“…Approximately 50% of patients with cardiac AL amyloidosis have low QRS voltage (<6 mm), 17 which has been attributed to insulation of the electric impulse on the surface ECG owing to infiltration. However, it is not seen in all patients and increased QRS voltages sometimes occur.…”

Section: Discussionmentioning

confidence: 99%

Quantification of Myocardial Extracellular Volume Fraction in Systemic AL Amyloidosis

Banypersad

Sado

Flett

et al. 2013

Circ: Cardiovascular Imaging

278

180

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Background— Cardiac involvement predicts outcome in systemic AL amyloidosis and influences therapeutic options. Current methods of cardiac assessment do not quantify myocardial amyloid burden. We used equilibrium contrast cardiovascular magnetic resonance (EQ-CMR) to quantify the cardiac interstitial compartment, measured as myocardial extracellular volume (ECV) fraction, hypothesizing it would reflect amyloid burden. Methods and Results— Sixty patients with systemic AL amyloidosis (65% men, median age 65 years) underwent conventional clinical cardiovascular magnetic resonance, including late enhancement, equilibrium contrast cardiovascular magnetic resonance, and clinical cardiac evaluation, including ECG, echocardiography, assays of N-terminal pro-brain natriuretic peptide and Troponin T, and functional assessment comprising the 6-minute walk test in ambulant individuals. Cardiac involvement in the amyloidosis patients was categorized as definite, probable, or none, suspected by conventional criteria. Findings were compared with 82 healthy controls. Mean ECV was significantly greater in patients than healthy controls (0.25 versus 0.40, P <0.001) and correlated with conventional criteria for characterizing the presence of cardiac involvement, the categories of none, probable, definite corresponding to ECV of 0.276 versus 0.342 versus 0.488, respectively ( P <0.001). ECV was correlated with cardiac parameters by echocardiography (eg, Tissue Doppler Imaging [TDI] S-wave R=0.52, P<0.001) and conventional cardiovascular magnetic resonance (eg, indexed left ventricular mass R =0.56, P <0.001). There were also significant correlations with N-terminal pro-brain natriuretic peptide ( R =0.69, P <0.001) and Troponin T ( R =0.53, P =0.006). ECV was associated with smaller QRS voltages ( R =0.57, P <0.001) and correlated with poorer performance in the 6-minute walk test ( R =0.36, P =0.03). Conclusions— Myocardial ECV measurement has potential to become the first noninvasive test to quantify cardiac amyloid burden.

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“…3 Combining echocardiographic and ECG testing, however, was shown to improve diagnostic accuracy of the test, but still without differentiating subtypes. 24 Role of strain imaging. There have been increasing data on the role of strain imaging in cardiac amyloidosis with both longitudinal and radial strains being reduced in the disease state.…”

Section: Echocardiographymentioning

confidence: 99%

Role of imaging in the diagnosis and management of patients with cardiac amyloidosis: State of the art review and focus on emerging nuclear techniques

AlJaroudi

Desai

Tang

et al. 2014

Journal of Nuclear Cardiology

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Amyloidosis is an infiltrative disease characterized by deposition of amyloid fibrils within the extracellular tissue of one or multiple organs. Involvement of the heart, cardiac amyloidosis, is recognized as a common cause of restrictive cardiomyopathy and heart failure. The two major types of cardiac amyloidosis are cardiac amyloid light-chain (AL) and transthyretin-related cardiac amyloidosis (ATTR, mutant and wild types) (Nat Rev Cardiol 2010;7:398-408). While early recognition of cardiac amyloidosis is of major clinical importance, so is the ability to differentiate between subtypes. Indeed, both prognosis and therapeutic options vary drastically depending on the subtype. While endomyocardial biopsy with immunostaining is considered the gold standard, advances in imaging provide an attractive non-invasive alternative. Currently, electrocardiography, echocardiography, and cardiac magnetic resonance imaging are all used in the evaluation of cardiac amyloidosis with varying diagnostic and prognostic accuracy. Yet, none of these modalities can effectively differentiate the cardiac amyloid subtypes. Recent data with 99m Tc-phosphate derivatives, previously used as bone seeking radioactive tracers, have shown promising results; these radiotracers selectively bind ATTR, but not AL subtype, and can differentiate subtypes with high diagnostic accuracy. This review will initially present the non-radionuclide imaging techniques and then focus on the radionuclide imaging techniques, particularly 99m Tc-DPD and 99m Tc-PYP, mechanism of action, performance and interpretation of the study, diagnostic accuracy, prognostic value, future clinical perspective, and outlook.

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Utility of Combined Indexes of Electrocardiography and Echocardiography in the Diagnosis of Biopsy Proven Primary Cardiac Amyloidosis

Abstract: Patients with clinically suspected primary CA, combined indexes of ECGs and ECHOs could be used as the noninvasive diagnostic tools.

Cited by 31 publications

References 12 publications

The Findings of Electrocardiography in Patients with Cardiac Amyloidosis

The Findings of Electrocardiography in Patients with Cardiac Amyloidosis

Quantification of Myocardial Extracellular Volume Fraction in Systemic AL Amyloidosis

Role of imaging in the diagnosis and management of patients with cardiac amyloidosis: State of the art review and focus on emerging nuclear techniques

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