Background

ST/T abnormalities recognized as electrocardiographic (ECG) left ventricular (LV) strain pattern are known as a marker of myocyte death and reduced survival. The purpose of this study was to determine whether ECG LV strain pattern, its components and atrial fibrillation (AF) predict lower survival at the time of diagnosis of systemic light chain (AL) amyloidosis.

Methods

12‑lead surface electrocardiogram (ECG), standard two-dimensional echocardiography, laboratory analyses were retrospectively evaluated within 2 months of diagnosis in 87 patients with biopsy-proven systemic AL amyloidosis from 2009 to 2017 in a single center. ECG strain pattern was defined as coexistence of ST-segment horizontal or downward sloping depression ≥0.05 mV at its most horizontal section and negative asymmetrical T-wave deeper than 0.1 mV in at least 1 of leads I,aVL,V1-V6. Patients with QRS >120 ms (BBB or major IVCD) were excluded from the analysis.

Results

Kaplan-Meier survival analysis revealed a 1.8-fold shorter overall survival (OS) at 2 years in the ECG strain (21% of participants) group (p = 0.0078), 2.0-fold shorter OS in the ST-segment depression (STd) (isolated and strain related as one group) (34% of participants) group (p < 0.0001), and 3.9-fold shorter OS in AF (23% of participants) group (p < 0.0001) compared with those without. Median survival of patients with STd and AF were and 13.0 (range 1–74) and 9.5 (range 1–74) months respectively. In univariate analysis STd and AF were stronger predictors of inferior OS than relative wall thickness, average E/e′ ratio, and LV ejection fraction, but weaker predictors of OS than B-type natriuretic peptide. In multivariate analysis STd and AF lost significance after adjustment for age, gender, number of organs involved and BNP.

Conclusions

ST-segment depression and AF were not significantly associated with reduced survival in AL amyloidosis at diagnosis.

中文翻译：

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系统性轻链淀粉样变性诊断时的心电图左心室应变模式、ST 段压低和心房颤动：发生率和临床意义

背景

被识别为心电图 (ECG) 左心室 (LV) 应变模式的 ST/T 异常被认为是心肌细胞死亡和存活率降低的标志。本研究的目的是确定心电图 LV 应变模式、其组成部分和心房颤动 (AF) 是否预测系统性轻链 (AL) 淀粉样变性诊断时的存活率较低。

方法

对 2009 年至 2017 年在单个中心进行的 87 名经活检证实的系统性 AL 淀粉样变患者在诊断后 2 个月内的 12 导联体表心电图 (ECG)、标准二维超声心动图、实验室分析进行了回顾性评估。心电图应变模式被定义为在其最水平部分的 ST 段水平或向下倾斜的压低≥0.05 mV，并且在 I、aVL、V1-V6 导联中的至少 1 个导联中存在深度大于 0.1 mV 的负不对称 T 波。QRS > 120 ms（BBB 或主要 IVCD）的患者被排除在分析之外。

结果

Kaplan-Meier 生存分析显示，ECG 应变组（21% 的参与者）的 2 年总生存期（OS）缩短了 1.8 倍（p  = 0.0078），ST 段压低（STd）组的 OS 缩短了 2.0 倍(隔离和应变相关为一组) (34% 的参与者) 组 ( p < 0.0001），AF（23% 的参与者）组（p < 0.0001）的 OS 比没有的组短 3.9 倍。STd 和 AF 患者的中位生存期分别为 13.0（范围 1-74）和 9.5（范围 1-74）个月。在单变量分析中，STd 和 AF 是比相对壁厚、平均 E/e' 比和 LV 射血分数更强的较差 OS 预测因子，但比 B 型利钠肽更弱的 OS 预测因子。在多变量分析中，STd 和 AF 在调整年龄、性别、受累器官数量和 BNP 后失去显着性。

结论

ST 段压低和 AF 与诊断时 AL 淀粉样变性的存活率降低没有显着相关性。