Combining ECG and echocardiography to identify transthyretin cardiac amyloidosis in heart failure
Aims/background Transthyretin amyloid (ATTR) amyloidosis cardiomyopathy is an underdiagnosed, causatively treatable cause of heart failure (HF). The aim of this study was to evaluate the efficacy of electrocardiogram (ECG) and echocardiography on patients with increased interventricular septum diame...
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Published in | Clinical physiology and functional imaging Vol. 41; no. 5; pp. 408 - 416 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Oxford
Wiley Subscription Services, Inc
01.09.2021
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Subjects | |
Online Access | Get full text |
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Summary: | Aims/background
Transthyretin amyloid (ATTR) amyloidosis cardiomyopathy is an underdiagnosed, causatively treatable cause of heart failure (HF). The aim of this study was to evaluate the efficacy of electrocardiogram (ECG) and echocardiography on patients with increased interventricular septum diameter (IVSd) to identify ATTR cardiac amyloidosis (ATTR‐CA) patients.
Methods
We investigated 58 patients with HF and an IVSd > 14 mm. Included were 33 ATTR‐CA patients and 25 controls that consisted of non‐amyloidosis HFpatients with negative 99mTc‐3,3‐diphosphono‐1,2‐propanodicarboxylic acid (DPD) scintigraphy. We used echocardiography including 2D speckle‐tracking strain and a 12‐lead ECG to test the accuracy to differentiate the groups.
Results
We found high diagnostic accuracy (98%) for differentiating ATTR‐CA from HF controls using a combination of R amplitude in ‐aVR from ECG and relative wall thickness acquired from echocardiography. With this combined model (RWT/R in ‐aVR), the sensitivity was 100% and specificity was 95% using a cut‐off value of 0.90. Furthermore, the area under the curve was 99% and the negative predictive value was 100%.
Conclusion
We found that a simple combination of ECG and echocardiographic parameters used in clinical settings was able to differentiate ATTR‐CA from other aetiologies of HF with increased interventricular septum thickness. The high sensitivity and negative predictive value render the algorithm useful for selection of patients for further diagnostic procedures for ATTR‐CA. |
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Bibliography: | Funding information The study was supported by Umeå University, The Swedish Heart and Lung foundation, grants no 20160787 and 20200160 and The Swedish Research Council grant no 2019‐01338. |
ISSN: | 1475-0961 1475-097X 1475-097X |
DOI: | 10.1111/cpf.12715 |