Combining ECG and echocardiography to identify transthyretin cardiac amyloidosis in heart failure

Area of Science:

• Cardiology
• Medical Diagnostics
• Cardiac Imaging

Background:

• Transthyretin amyloid (ATTR) amyloidosis cardiomyopathy is an underdiagnosed cause of heart failure (HF).
• Early diagnosis and treatment of ATTR-CA are crucial for managing heart failure.
• Increased interventricular septum diameter (IVSd) can be an indicator for further investigation.

Purpose of the Study:

• To evaluate the efficacy of electrocardiogram (ECG) and echocardiography in identifying ATTR cardiac amyloidosis (ATTR-CA) patients.
• To assess the diagnostic accuracy of combined ECG and echocardiographic parameters in differentiating ATTR-CA from other HF etiologies.
• To determine if simple clinical parameters can aid in selecting patients for ATTR-CA diagnosis.

Main Methods:

• Study included 58 patients with HF and IVSd > 14 mm (33 ATTR-CA, 25 controls).
• Controls were HF patients without amyloidosis confirmed by negative 99mTc-DPD scintigraphy.
• Echocardiography (including 2D speckle-tracking strain) and 12-lead ECG were used for differentiation.

Main Results:

• A combined model using R amplitude in -aVR (ECG) and relative wall thickness (echocardiography) achieved 98% diagnostic accuracy.
• The model demonstrated 100% sensitivity, 95% specificity, and 100% negative predictive value for ATTR-CA detection.
• The area under the curve for the combined model was 99%.

Conclusions:

• A simple combination of ECG and echocardiographic parameters can differentiate ATTR-CA from other HF causes with increased interventricular septum thickness.
• The high sensitivity and negative predictive value of this combined approach make it valuable for patient selection.
• This algorithm facilitates the identification of patients requiring further diagnostic procedures for ATTR-CA.