Are classic predictors of voltage valid in cardiac amyloidosis? A contemporary analysis of electrocardiographic findings
Are classic predictors of voltage valid in cardiac amyloidosis? A contemporary analysis of electrocardiographic findings
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DOI：
10.1016/j.ijcard.2016.04.030
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发表时间：
2016-07-01
影响因子：
3.5
通讯作者：
Hanna, Mazen
中科院分区：
文献类型：
--
作者：
Sperry, BrettW.;Vranian, Michael N.;Hanna, Mazen
背景：低电压心电图伴室壁厚度增加是心脏淀粉样变性的特征。然而，影响普通人群电压的患者特征，包括束支传导阻滞，在淀粉样心脏病中尚未得到评估。方法：对2002-2014年间新诊断的心脏淀粉样变性患者进行回顾性分析。按肢体(I、II、III导联QRS波群之和)和心前区(Sokolow：V1的S+V5~V6的R)标准计算心电图电压。使用多变量线性回归检验电压和临床变量之间的关系。结果：在389名受试者(转甲状腺素ATTR186例，轻链AL203例)中，30%有传导延迟(QRS和GT；120ms)。在QRS狭窄的患者中，68%的患者符合下肢标准，72%的患者符合低Sokolow标准，57%的患者同时符合这两个标准，AL和ATTR的电压较低。在心脏淀粉样变性队列中，LV质量指数以及其他影响电压的典型因素(年龄、性别、种族、高血压、BSA和吸烟)与电压无关。与QRS狭窄的患者相比，LBBB和IVCD患者的电压相似。在多变量调整后，电压与死亡率显著相关(P<；两个标准均为0.001)。结论：在普通人群中预测心电图电压的经典指标不适用于心脏淀粉样变性。在这个队列中，心室传导延迟和低电压的患病率估计比以前报道的要高。电压预测多变量调整后的死亡率。(C)2016爱思唯尔爱尔兰有限公司。保留所有权利。
Background: Low voltage electrocardiography (ECG) coupled with increased ventricular wall thickness is the hallmark of cardiac amyloidosis. However, patient characteristics influencing voltage in the general population, including bundle branch block, have not been evaluated in amyloid heart disease.Methods: A retrospective analysis was performed of patients with newly diagnosed cardiac amyloidosis from 2002 to 2014. ECG voltage was calculated using limb (sum of QRS complex in leads I, II and III) and precordial (Sokolow: S in V1 plus R in V5-V6) criteria. The associations between voltage and clinical variables were tested using multivariable linear regression. A Cox model assessed the association of voltage with mortality.Results: In 389 subjects (transthyretin ATTR 186, light chain AL 203), 30% had conduction delay (QRS >120 ms). In those with narrow QRS, 68% met low limb, 72% low Sokolow and 57% both criteria, with lower voltages found in AL vs ATTR. LV mass index as well as other typical factors that impact voltage (age, sex, race, hypertension, BSA, and smoking) in the general population were not associated with voltage in this cardiac amyloidosis cohort. Patients with LBBB and IVCD had similar voltages when compared to those with narrow QRS. Voltage was significantly associated with mortality (p < 0.001 for both criteria) after multivariable adjustment.Conclusion: Classic predictors of ECG voltage in the general population are not valid in cardiac amyloidosis. In this cohort, the prevalence estimates of ventricular conduction delay and low voltage are higher than previously reported. Voltage predicts mortality after multivariable adjustment. (c) 2016 Elsevier Ireland Ltd. All rights reserved.