A peripheral QRS amplitude ≤24.5 mm identified cardiac involvement in AL amyloidosis with 58.72% sensitivity and 80.00% specificity, and predicted survival in Mayo stage II patients.
Observational (n=337)
No
Does the definition of low QRS voltage impact its diagnostic and prognostic value in patients with AL amyloidosis?
The prevalence and diagnostic utility of low QRS voltages in AL amyloidosis vary significantly based on the specific ECG criteria used, with low peripheral voltages also offering prognostic value in intermediate-risk patients.
Effect estimate: AUC 0.763 (95% CI 0.712-0.808)
BACKGROUND: In cardiac AL amyloidosis, myocardial infiltration is typically associated with "low QRS voltages" at the 12-lead electrocardiogram (ECG). Although considered as one of the hallmarks of the disease, its reported prevalence varies from 45% to 70%, mainly because of nonhomogeneous definitions. METHODS: To identify the "low QRS voltage" parameter having the best diagnostic value in identifying cardiac amyloidosis, and to assess its possible prognostic role, ECG and echocardiographic data were collected at diagnosis in 337 consecutive never-treated AL patients (233 with, 104 without cardiac involvement). Prognosis was assessed after a median follow-up of 14.5 months. RESULTS: "Low QRS voltage" prevalence varied from 84.12% when using Sokolow-Lyon index ≤15 mm to 27.04% with the definition of low total voltages (QRS amplitude ≤5 mm in each peripheral and ≤10 mm in each precordial lead), the widely used definition of low peripheral voltages (≤5 mm in each peripheral lead) being able to identify 66.52% cardiac AL patients. The presence of "low peripheral voltages" was associated with a more severe cardiac involvement, and was able to differentiate Mayo stage II patients' survival (i.e., AL patients with intermediate prognosis). According to receiver operator characteristic (ROC) curve analysis, sensitivity and specificity were 58.72% and 80.00%, for a peripheral QRS amplitude ≤24.5 mm (the sum of QRS in all the 6 peripheral leads), and 76.26% and 65.00% for a Sokolow-Lyon index ≤11 mm. CONCLUSIONS: In cardiac AL amyloidosis the prevalence of low QRS voltages is highly dependent on the method used for defining this ECG alteration.
Mussinelli et al. (Sun,) conducted a observational in AL Amyloidosis (n=337). Low QRS voltages (ECG parameter) vs. Normal QRS voltages was evaluated on Diagnostic accuracy of peripheral QRS amplitude ≤24.5 mm for identifying cardiac involvement (AUC 0.763, 95% CI 0.712-0.808). A peripheral QRS amplitude ≤24.5 mm identified cardiac involvement in AL amyloidosis with 58.72% sensitivity and 80.00% specificity, and predicted survival in Mayo stage II patients.