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Holter monitoring in AL amyloidosis: prognostic implications
G Palladini1, G Malamani, F Cò
1Department of Internal Medicine and Medical Oncology, University of Pavia, Italy.
Insights
Primary (AL) amyloidosis frequently affects the heart, leading to death. Holter monitoring reveals arrhythmias like couplets, which predict survival and sudden cardiac death in these patients.
Area of Science:
- Cardiology
- Electrophysiology
- Amyloidosis Research
Background:
- Cardiac involvement is prevalent in primary (AL) amyloidosis, often causing mortality.
- Rhythm and conduction disturbances are common terminal events in AL amyloidosis.
- Understanding cardiac abnormalities is crucial for prognosis.
Purpose of the Study:
- To identify Holter monitoring abnormalities in AL amyloidosis patients.
- To evaluate the prognostic value of these Holter findings, especially for sudden death.
- To correlate Holter data with echocardiographic findings and clinical outcomes.
Main Methods:
- Fifty-one AL amyloidosis patients underwent comprehensive clinical evaluation, echocardiography, and 24-hour Holter monitoring.
- Echocardiographic signs of cardiac involvement and heart failure were assessed.
- Ventricular arrhythmias, including couplets and nonsustained ventricular tachycardia, were analyzed from Holter recordings.
Main Results:
- Cardiac involvement was present in 55% of patients; 23% had heart failure.
- Complex ventricular arrhythmias were detected in 57%, with couplets in 29% and nonsustained ventricular tachycardia in 18%.
- Congestive heart failure, echocardiographic abnormalities, and Holter abnormalities negatively impacted survival (median 23.4 months).
Conclusions:
- Interventricular septum thickness and the presence of couplets on Holter monitoring are independent predictors of survival in AL amyloidosis.
- Couplets on Holter monitoring correlate significantly with sudden cardiac death.
- Holter monitoring is a valuable tool for assessing prognosis in patients with AL amyloidosis.
Abstract:
The heart is involved in more than one third of patients with primary (AL) amyloidosis at diagnosis and it is by far the most common cause of death. Rhythm and conduction abnormalities generally represent the terminal event. The aims of this study were to determine the spectrum of Holter abnormalities found in AL amyloidosis and to assess their prognostic significance, particularly in relation to sudden death. Fifty-one patients with AL amyloidosis were included, and all of them had a complete history, physical examination, two-dimensional echocardiography, and 24-hour Holter monitoring. Fifty-five percent of these patients had echographic signs of heart involvement and 23% had heart failure. Complex ventricular arrhythmias were found in 57% of patients, couplets in 29%, and nonsustained ventricular tachycardia in 18%. Overall median survival was 23.4 months. Congestive heart failure, echocardiographic abnormalities, and Holter abnormalities adversely affected survival. The multivariate analysis demonstrated that interventricular septum thickness and couplets were independent predictors of survival. The presence of couplets correlated with sudden death. Holter monitoring may contribute to assessing the prognosis of patients with AL amyloidosis.