Electrocardiographic assessment of ventricular repolarization variables in patients with wild-type transthyretin amyloid cardiomyopathy

INTRODUCTION Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is a progressive infiltrative cardiomyopathy characterized by extracellular deposition of misfolded transthyretin protein. This condition has been associated with an increased risk of ventricular arrhythmias. Electrocardiographic repolarization indices such as Tp-e interval and Tp-e/QT ratios are emerging as markers of arrhythmic risk. This study aimed to evaluate ventricular repolarization parameters in ATTRwt-CM patients compared to healthy individuals. METHODS 95 newly diagnosed ATTRwt-CM patients and 95 age- and sex-matched healthy controls were enrolled between August 2023 and August 2025. Electrocardiographic parameters, including Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, were measured. Left ventricular mass index (LVMI), left atrial volume index (LAVI), and left ventricular diastolic function parameters were evaluated via echocardiography. RESULTS The Tp-e interval (81.7 ± 4.6 ms vs. 71.1 ± 5.7 ms; p < 0.001), Tp-e/QT ratio (0.21 ± 0.01 vs. 0.19 ± 0.02; p < 0.001), and Tp-e/QTc ratio (0.18 ± 0.01 vs. 0.17 ± 0.01; p < 0.001) were significantly prolonged in the ATTRwt-CM group. A significant positive correlation was observed between Tp-e indices and LVMI, LAVI, mean E/e' ratio, and NT-proBNP levels. CONCLUSION Our study showed that Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are evaluated electrocardiographically in patients with ATTRwt-CM, were prolonged compared with normal healthy individuals. A positive correlation was determined between repolarization parameters and markers of myocardial remodeling. We believe that pre-treatment evaluation of repolarization parameters in ATTRwt-CM patients would be beneficial for predicting ventricular arrhythmia risk.