Diagnostic and Prognostic Value of Low QRS Voltages in Cardiac AL Amyloidosis

Mussinelli, Roberta; Salinaro, Francesco; Alogna, Alessio; Boldrini, Michele; Raimondi, Ambra; Musca, Francesco; Palladini, Giovanni; Merlini, Giampaolo; Perlini, Stefano

doi:10.1111/anec.12036

Cited by 88 publications

(70 citation statements)

References 39 publications

(67 reference statements)

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“…Conventional 12-lead electrocardiograms were also recorded with standard instrument sensitivity of 10 mm ¼ 1 mV. If no QRS deflection was greater than 5 mm in any limb lead, the definition of 'low QRS voltages' by limb lead criteria was satisfied [23][24][25]. Patients with cardiac involvement and clinical signs or symptoms of heart failure whose ejection fraction was above 50% were defined as presenting diastolic heart failure or heart failure with normal (preserved) ejection fraction (HFpEF) [9].…”

Section: Methodsmentioning

confidence: 99%

Prognostic value of depressed midwall systolic function in cardiac light-chain amyloidosis

Perlini¹,

Salinaro²,

Musca³

et al. 2014

Journal of Hypertension

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Section: Methodsmentioning

confidence: 99%

Prognostic value of depressed midwall systolic function in cardiac light-chain amyloidosis

Perlini¹,

Salinaro²,

Musca³

et al. 2014

Journal of Hypertension

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“…In contemporary series, however, the prevalence of low voltage varies with etiology, ranging from 60% in AL to 20% in ATTR 44, 45 . The absence of low QRS voltages does not, therefore, preclude CA, especially in patients with ATTRwt in whom left ventricular hypertrophy or left bundle branch block is present in up to 30% of patients.…”

Section: Diagnosing Cardiac Amyloidosismentioning

confidence: 99%

Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis

et al. 2017

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Advances in cardiac imaging have resulted in greater recognition of cardiac amyloidosis (CA) in everyday clinical practice, but the diagnosis continues to be made in patients with late stage disease, suggesting that more needs to be done to improve awareness of its clinical manifestations and the potential of therapeutic intervention to improve prognosis. Light chain CA (AL-CA) in particular, if recognized early and treated with targeted plasma cell therapy, can be managed very effectively. For patients with transthyretin amyloidosis, there are numerous therapies that are currently in late phase clinical trials. In this review we address common questions encountered in clinical practice regarding etiology, clinical presentation, diagnosis and management of cardiac amyloidosis, focusing on recent important developments in cardiac imaging and biochemical diagnosis. The aim is to show how a systematic approach to the evaluation of suspected CA can impact the prognosis of patients in the modern era.

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“…The presence of low voltage is associated with worse outcome 19 with various areas-under the curves depending on which voltage criteria are used. Fragmented QRS is also associated with worse outcome (HR 1.572 death hazard ratio [1.03-2.40], P = .038).…”

Section: Prognostic Valuementioning

confidence: 99%

Role of imaging in the diagnosis and management of patients with cardiac amyloidosis: State of the art review and focus on emerging nuclear techniques

AlJaroudi

Desai

Tang

et al. 2014

Journal of Nuclear Cardiology

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Amyloidosis is an infiltrative disease characterized by deposition of amyloid fibrils within the extracellular tissue of one or multiple organs. Involvement of the heart, cardiac amyloidosis, is recognized as a common cause of restrictive cardiomyopathy and heart failure. The two major types of cardiac amyloidosis are cardiac amyloid light-chain (AL) and transthyretin-related cardiac amyloidosis (ATTR, mutant and wild types) (Nat Rev Cardiol 2010;7:398-408). While early recognition of cardiac amyloidosis is of major clinical importance, so is the ability to differentiate between subtypes. Indeed, both prognosis and therapeutic options vary drastically depending on the subtype. While endomyocardial biopsy with immunostaining is considered the gold standard, advances in imaging provide an attractive non-invasive alternative. Currently, electrocardiography, echocardiography, and cardiac magnetic resonance imaging are all used in the evaluation of cardiac amyloidosis with varying diagnostic and prognostic accuracy. Yet, none of these modalities can effectively differentiate the cardiac amyloid subtypes. Recent data with 99m Tc-phosphate derivatives, previously used as bone seeking radioactive tracers, have shown promising results; these radiotracers selectively bind ATTR, but not AL subtype, and can differentiate subtypes with high diagnostic accuracy. This review will initially present the non-radionuclide imaging techniques and then focus on the radionuclide imaging techniques, particularly 99m Tc-DPD and 99m Tc-PYP, mechanism of action, performance and interpretation of the study, diagnostic accuracy, prognostic value, future clinical perspective, and outlook.

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Diagnostic and Prognostic Value of Low QRS Voltages in Cardiac AL Amyloidosis

Abstract: In cardiac AL amyloidosis the prevalence of low QRS voltages is highly dependent on the method used for defining this ECG alteration.

Cited by 88 publications

References 39 publications

Prognostic value of depressed midwall systolic function in cardiac light-chain amyloidosis

Prognostic value of depressed midwall systolic function in cardiac light-chain amyloidosis

Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis

Role of imaging in the diagnosis and management of patients with cardiac amyloidosis: State of the art review and focus on emerging nuclear techniques

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