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Signal-averaged electrocardiography in patients with AL (primary) amyloidosis
S W Dubrey1, S Bilazarian, M LaValley
1Division of Cardiology, Boston University School of Medicine, MA, USA.
Insights
Late potentials detected by signal-averaged electrocardiograms predict sudden cardiac death in patients with AL amyloidosis, especially those with abnormal echocardiograms.
Area of Science:
- Cardiology
- Electrophysiology
- Amyloidosis Research
Background:
- Light-chain (AL) amyloidosis frequently affects the heart, leading to significant morbidity and mortality.
- Cardiac involvement in AL amyloidosis can manifest as arrhythmias and sudden cardiac death.
- Predictive markers for sudden cardiac death in AL amyloidosis are crucial for patient management.
Purpose of the Study:
- To investigate the prognostic value of electrocardiographic findings, particularly late potentials, in patients with biopsy-proven AL amyloidosis.
- To determine the relationship between echocardiographic evidence of cardiac amyloidosis and mortality.
- To assess whether signal-averaged electrocardiograms provide independent prognostic information for sudden cardiac death.
Main Methods:
- Study included 133 patients with biopsy-proven AL amyloidosis.
- Data collected via echocardiography, Holter monitoring, 12-lead ECG, and signal-averaged electrocardiograms (SAECG).
- Analysis focused on the association between test features and patient mortality, including sudden cardiac death.
Main Results:
- Late potentials were significantly more frequent in patients with echocardiographic cardiac amyloidosis (31%) versus normal echocardiograms (9%).
- Abnormal echocardiograms and SAECGs independently predicted all-cause cardiac death and sudden cardiac death (p < 0.0001).
- Abnormal SAECGs were independently predictive of sudden death in patients with abnormal echocardiograms (p < 0.05).
Conclusions:
- Late potentials identified by SAECG are significant predictors of sudden death in AL amyloidosis.
- SAECG provides independent prognostic information for sudden cardiac death in patients with echocardiographic evidence of cardiac amyloidosis.
- These findings highlight the utility of SAECG in risk stratification for AL amyloidosis patients.
Abstract:
One hundred thirty-three patients with biopsy-proven AL amyloidosis were studied with echocardiography, Holter recording, 12-lead electrocardiography, and signal-averaged electrocardiograms. Features from these tests were analyzed in relation to their effect on mortality. Late potentials were more frequent in patients with echocardiographic evidence of cardiac amyloidosis (31%) compared with patients with normal echocardiograms (9%, p < 0.003). One hundred six of the 133 patients died during follow-up, of which 34 were nonsudden cardiac deaths and 33 were sudden deaths. Abnormal echocardiograms and signal-averaged electrocardiograms were each predictive of all-cause cardiac death (p < 0.0001 ) and sudden cardiac death (p < 0.0001). Abnormal signal-averaged electrocardiograms were also independently predictive of sudden death in the subgroup of patients with an abnormal echocardiogram (p < 0.05). Thus late potentials are predictive of sudden death in patients with AL amyloidosis and provide independent prognostic information in patients with echocardiographic evidence of amyloid involvement.