Prevalence and prognostic value of conduction disturbances at the time of diagnosis of cardiac AL amyloidosis

Ann Noninvasive Electrocardiol. 2013 Jul;18(4):327-35. doi: 10.1111/anec.12032. Epub 2013 Jan 20.

Abstract

Background and purpose: To evaluate the prevalence and the prognostic implications of conduction delays in a large cohort of cardiac AL patients.

Methods: Echo Doppler and 12-lead ECG were collected in 344 consecutive patients in whom diagnosis of AL amyloidosis was concluded between 2008 and 2010. Patients were subdivided according to the presence (n = 240) or absence (n = 104) of cardiac involvement.

Results: When compared with patients without myocardial involvement, cardiac AL was associated with prolonged PQ, QRS, QT and QTc intervals (P < 0.05), and with higher prevalence of intraventricular blocks (27.5% vs. 16.5%, P < 0.05), that was associated with higher wall thickness, worse diastolic and regional systolic function, higher NT-proBNP values (all P < 0.05), and higher mortality (P = 0.0001; median follow-up: 402 days).

Conclusion: Intraventricular conduction delays have a negative prognostic impact in patients with cardiac AL amyloidosis. Their presence should not be overlooked in the diagnostic workup, prompting a more accurate cardiological support.

Keywords: amyloid; conduction disturbances; echocardiography; electrocardiography; prognosis.

Publication types

  • Comparative Study

MeSH terms

  • Age Distribution
  • Aged
  • Amyloidosis / diagnosis
  • Amyloidosis / epidemiology*
  • Amyloidosis / physiopathology
  • Analysis of Variance
  • Arrhythmias, Cardiac / diagnosis*
  • Arrhythmias, Cardiac / epidemiology*
  • Biomarkers / analysis
  • Brugada Syndrome
  • Cardiac Conduction System Disease
  • Cardiomyopathies / diagnosis
  • Cardiomyopathies / epidemiology*
  • Cardiomyopathies / physiopathology
  • Cohort Studies
  • Echocardiography, Doppler / methods*
  • Electrocardiography / methods*
  • Female
  • Heart Conduction System / abnormalities*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Natriuretic Peptide, Brain / analysis
  • Peptide Fragments / analysis
  • Prevalence
  • Prognosis
  • Proportional Hazards Models
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sex Distribution
  • Statistics, Nonparametric
  • Survival Rate

Substances

  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain