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Background <p>Cardiac involvement in light chain amyloidosis (AL-CA) represents an infiltrative heart disease. The aim of the study was to recognize differences between patients suffering from light chain amyloidosis with and without cardiac involvement in 12-lead electrocardiography (ECG) and 24-h Holter ECG monitoring.</p> Methods <p>We prospectively analyzed data in 39 (median 66 [IQR 62;71] years, 62% males) consecutive patients with AL amyloidosis.</p> Results <p>Out of all patients, AL-CA was confirmed in 26 (67%) subjects. All patients with AL-CA manifested at least one pathology ECG, which contrasted with a low prevalence of abnormal ECG findings in patients without cardiac involvement (54%), p &lt; 0.001. Abnormal Holter ECG findings were documented in 77% and 62% of patients with and without AL-CA. During 19 (7;59) months of follow-up, 19 (73%) patients with AL-CA died. The mortality rate was significantly lower in patients with QRS &lt; 100&#xa0;ms and QTc &lt; 450&#xa0;ms (both p &lt; 0.05). The absence of any pathology on 12-lead ECG had a negative predictive value of 100% for the presence of AL-CA.</p> Conclusion <p>Standard 12-lead ECG seems to be a method with a relevant negative predictive value for the exclusion of AL-CA. The duration of QRS as well as QTc intervals seem to be a marker of early mortality.</p>

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Clinical and Prognostic Implications of Electrocardiography and Holter Monitoring Findings in Patients with Light Chain Cardiac Amyloidosis

  • 期刊论文

  • 发表日期：

    2025年2月5日

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  • Zdenka Fingrova,
  • Stepan Havranek,
  • Petr Kuchynka,
  • Jan Habasko,
  • Ales Linhart,
  • Tomas Palecek

摘要

Background

Cardiac involvement in light chain amyloidosis (AL-CA) represents an infiltrative heart disease. The aim of the study was to recognize differences between patients suffering from light chain amyloidosis with and without cardiac involvement in 12-lead electrocardiography (ECG) and 24-h Holter ECG monitoring.

Methods

We prospectively analyzed data in 39 (median 66 [IQR 62;71] years, 62% males) consecutive patients with AL amyloidosis.

Results

Out of all patients, AL-CA was confirmed in 26 (67%) subjects. All patients with AL-CA manifested at least one pathology ECG, which contrasted with a low prevalence of abnormal ECG findings in patients without cardiac involvement (54%), p < 0.001. Abnormal Holter ECG findings were documented in 77% and 62% of patients with and without AL-CA. During 19 (7;59) months of follow-up, 19 (73%) patients with AL-CA died. The mortality rate was significantly lower in patients with QRS < 100 ms and QTc < 450 ms (both p < 0.05). The absence of any pathology on 12-lead ECG had a negative predictive value of 100% for the presence of AL-CA.

Conclusion

Standard 12-lead ECG seems to be a method with a relevant negative predictive value for the exclusion of AL-CA. The duration of QRS as well as QTc intervals seem to be a marker of early mortality.