In Cases of Cardiac Amyloidosis Increased Wall Thickness Is more Common than the Typical Electrocardiogram Signs – ne töröld
█ Original article
Nagy Daniella1, Peskó Gergely1, Tóth András Dávid1, Révész Katalin1, Varga Gergely1, Vágó Hajnalka2, Czibor Sándor3, Masszi Tamás1, Pozsonyi Zoltán1
1Semmelweis Egyetem, Belgyógyászati és Hematológiai Klinika, Budapest
2Semmelweis Egyetem, Városmajor Szív- és Érgyógyászati Klinika, Budapest
3Semmelweis Egyetem, Nukleáris Medicina Tanszék, Budapest
Background: Cardiac amyloidosis is considered a rare disease, without treatment it can promptly become fatal. In recent years more cases are diagnosed due to the rapidly developing diagnostic and treatment options. In the diagnostic procedure ECG and echocardiography have substantial significance.
Objective: The aim of the study was to investigate the incidence of the electrocardiogram (ECG) signs (low voltage and pseudo infarct pattern) that are considered typical for CA, and the increased wall thickness IWT (≥12 mm) between our patients according to the new cardiac amyloidosis guideline of European Society of Cardiology (ESC), published in 2021, furthermore, to examine if the incidence of IWT and the typical ECG signs differ across diverse CA patologies in our patients.
Methods: In the retrospective analysis 104 CA patients were included who were registered at the Semmelweis University, Department of Internal Medicine and Hematology, between January 2009 and April 2022. According to the pathology of CA three groups were created: light chain amyloidosis (AL), wild type transthyretin amyloidosis (ATTRwt) and mutant type transthyretin amyloidosis (ATTRv). The most important demographic, clinical, ECG and echocardiography and laboratory parameters in the three groups were described and compared.
Results: The median age of the patients was 68 (59–78) years, 55% (n=57) were male. 71 had AL amyloidosis, 19 had ATTRwt and 13 had ATTRv. In ECG the incidence of low voltage was 54% (n=56) and pseudo infarct pattern was 56% (n=58). With echocardiography the septum and the posterior wall were measured in 2D mode, the septal and the posterior wall thickness were averaged in each case. The median value with this method was 16 (14–18) mm. In 91% (n=95) of the patients we measured IWT. Regarding the main objective of the study, the difference between the incidence of IWT thicker than or equal to 12 mm) and that of low voltage or of pseudo infarct pattern was significant amongst all patients (91% vs. 54% and 91% vs. 56%; p<0.001).
Greater degree of wall thickening was found in the ATTR group than in the AL group (p=0.01). 9 AL patients had no IWT.
Discussion: Low voltage – which is considered common in CA – was present in 56% of the sample, whereas pseudo infarct pattern in 58%. With echocardiography IWT was present in 91% of the cases. These data suggests that in accordance with the cardiac amyloidosis guidelines of European Society of Cardiology, it is neither low voltage, nor pseudo infarct pattern that should point to the presence of CA, but IWT on echocardiography. In diagnostic processes clinical symptoms, heart failure and other alerting signs have great importance as well.