ECG/echo indexes in the diagnostic approach to amyloid cardiomyopathy : A head-to-head comparison from the AC-TIVE study
Copyright © 2023. Published by Elsevier B.V..
BACKGROUND AND AIMS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:122 |
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| Enthalten in: |
European journal of internal medicine - 122(2024) vom: 19. Apr., Seite 68-77 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Pagura, Linda [VerfasserIn] |
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| Links: |
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| Themen: |
Amyloid cardiomyopathy |
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| Anmerkungen: |
Date Completed 08.04.2024 Date Revised 08.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ejim.2023.09.026 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM363508759 |
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| 100 | 1 | |a Pagura, Linda |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a ECG/echo indexes in the diagnostic approach to amyloid cardiomyopathy |b A head-to-head comparison from the AC-TIVE study |
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| 500 | |a Date Completed 08.04.2024 | ||
| 500 | |a Date Revised 08.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023. Published by Elsevier B.V. | ||
| 520 | |a BACKGROUND AND AIMS: 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 | ||
| 520 | |a METHODS: 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 | ||
| 520 | |a RESULTS: 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) | ||
| 520 | |a CONCLUSIONS: 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 | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Amyloid cardiomyopathy | |
| 650 | 4 | |a ECG/echo indexes | |
| 650 | 4 | |a Echocardiography | |
| 650 | 4 | |a Electrocardiogram | |
| 650 | 4 | |a Left ventricular mass | |
| 650 | 4 | |a Light chain amyloidosis | |
| 650 | 4 | |a Red flags | |
| 650 | 4 | |a Transthyretin amyloidosis | |
| 650 | 4 | |a Voltages | |
| 700 | 1 | |a Porcari, Aldostefano |e verfasserin |4 aut | |
| 700 | 1 | |a Cameli, Matteo |e verfasserin |4 aut | |
| 700 | 1 | |a Biagini, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Canepa, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Crotti, Lia |e verfasserin |4 aut | |
| 700 | 1 | |a Imazio, Massimo |e verfasserin |4 aut | |
| 700 | 1 | |a Forleo, Cinzia |e verfasserin |4 aut | |
| 700 | 1 | |a Pavasini, Rita |e verfasserin |4 aut | |
| 700 | 1 | |a Limongelli, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Perlini, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Metra, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Boriani, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Emdin, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Sinagra, Gianfranco |e verfasserin |4 aut | |
| 700 | 1 | |a Merlo, Marco |e verfasserin |4 aut | |
| 700 | 0 | |a ACTIVE study group |e verfasserin |4 aut | |
| 700 | 1 | |a Longo, Francesca |e investigator |4 oth | |
| 700 | 1 | |a Rossi, Maddalena |e investigator |4 oth | |
| 700 | 1 | |a Varrà, Guerino Giuseppe |e investigator |4 oth | |
| 700 | 1 | |a Saro, Riccardo |e investigator |4 oth | |
| 700 | 1 | |a Dore, Franca |e investigator |4 oth | |
| 700 | 1 | |a Girardi, Francesca |e investigator |4 oth | |
| 700 | 1 | |a Vergaro, Giuseppe |e investigator |4 oth | |
| 700 | 1 | |a Musumeci, Beatrice |e investigator |4 oth | |
| 700 | 1 | |a Autore, Camillo |e investigator |4 oth | |
| 700 | 1 | |a Cappelli, Francesco |e investigator |4 oth | |
| 700 | 1 | |a Perfetto, Federico |e investigator |4 oth | |
| 700 | 1 | |a Olivotto, Iacopo |e investigator |4 oth | |
| 700 | 1 | |a Favale, Stefano |e investigator |4 oth | |
| 700 | 1 | |a Carella, Maria Cristina |e investigator |4 oth | |
| 700 | 1 | |a Guaricci, Andrea Igoren |e investigator |4 oth | |
| 700 | 1 | |a Ciccone, Marco Matteo |e investigator |4 oth | |
| 700 | 1 | |a Di Bella, Gianluca |e investigator |4 oth | |
| 700 | 1 | |a Tomasoni, Daniela |e investigator |4 oth | |
| 700 | 1 | |a Rella, Valeria |e investigator |4 oth | |
| 700 | 1 | |a Branzi, Giovanna |e investigator |4 oth | |
| 700 | 1 | |a Badano, Luigi |e investigator |4 oth | |
| 700 | 1 | |a Parati, Gianfranco |e investigator |4 oth | |
| 700 | 1 | |a Palmiero, Giuseppe |e investigator |4 oth | |
| 700 | 1 | |a Caiazza, Martina |e investigator |4 oth | |
| 700 | 1 | |a Caponetti, Angelo Giuseppe |e investigator |4 oth | |
| 700 | 1 | |a Saturi, Giulia |e investigator |4 oth | |
| 700 | 1 | |a Labate, Marianna Eleonora |e investigator |4 oth | |
| 700 | 1 | |a Andreis, Alessandro |e investigator |4 oth | |
| 700 | 1 | |a Paneva, Elena |e investigator |4 oth | |
| 700 | 1 | |a De Ferrari, Gaetano Maria |e investigator |4 oth | |
| 700 | 1 | |a Di Ienno, Luca |e investigator |4 oth | |
| 700 | 1 | |a De Carli, Giuseppe |e investigator |4 oth | |
| 700 | 1 | |a Giacomin, Elisa |e investigator |4 oth | |
| 700 | 1 | |a Arzilli, Chiara |e investigator |4 oth | |
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