CLINICAL AND PROGNOSTIC IMPLICATIONS OF ELECTROCARDIOGRAPHY AND HOLTER MONITORING IN PATIENTS WITH AL CARDIAC AMYLOIDOSIS

Aim: Cardiac involvement in AL amyloidosis (AL-CA) represents an infiltrative heart disease with poor prognosis. Aim of the study was to recognise differences between patients suffering from AL amyloidosis with and without AL-CA in 12-lead electrocardiography (ECG) and 24hr Holter ECG monitoring and identify dependence of ECG and Holter ECG monitoring on disease progression.
Methods: We prospectively analyzed clinical profile, echocardiographical pattern, ECG and 24hr Holter monitoring in 39 (66 [62;71] years, 62% males) consecutive patients with AL amyloidosis screened to cardiac involvement.
Results: Out of all patients, AL-CA was confirmed in 26 (67%) subjects. All patients with AL-CA manifested at least one pathology on 12-lead ECG, which contrasted with low prevalence of abnormal ECG finding in patients without cardiac involvement (54%), p < 0.001. Abnormal Holter ECG findings were documented in 77 % and 62 % of patients with and without cardiac involvement, respectively. Patients with AL-CA and E/A or E/e´ ratios above median manifested higher numbers of premature ventricular contractions than the rest of the subjects (median 195 [31; 546] vs. 6 [3; 40]; p = 0.02, and 195 [31; 274] vs. 14 [5; 54]; p = 0.04, respectively). During 19 (7; 59) months follow-up, 19 (73%) patients with AL-CA died. The mortality rate waw significantly lower in patients with QRS < 100ms and QTc < 450ms (both p < 0.05). The absence of any pathology on 12-lead ECG had negative predictive value 100% and positive predictive value 79% for the presence of AL-CA.
Conclusion: Standard 12-lead ECG seems to be a method with a relevant negative predictive value for exclusion of AL-CA. Advanced AL-CA is associated with a higher number of both premature atrial and ventricular beats. QRS and QTc duration seems to be a marker of early mortality of patients with AL-CA.