Key result
A Cornell LV mass-voltage ratio > 6.7 gm/m2/mV was significantly associated with an increased risk of heart failure hospitalization (HR 2.25) in patients with cardiac amyloidosis.
Why the study?
In cardiac amyloidosis, amyloid infiltration increases LV mass disproportionate to EKG voltage, but the relationship between LV mass-voltage ratio and clinical outcomes was not fully characterized.
Does an increased indexed left ventricular mass to QRS voltage ratio predict heart failure hospitalizations and mortality in patients with cardiac amyloidosis?
Cohort (n=85)
No
Does an increased indexed left ventricular mass to QRS voltage ratio predict heart failure hospitalizations and mortality in patients with cardiac amyloidosis?
In patients with cardiac amyloidosis, an elevated CMR-derived indexed LV mass-to-voltage ratio is an independent predictor of subsequent heart failure hospitalization.
May support risk stratification in cardiac amyloidosis; hypothesis-generating and requires prospective validation before clinical use.
In cardiac amyloidosis (CA), amyloid infiltration results in increased left ventricular (LV) mass disproportionate to electrocardiographic (EKG) voltage. We assessed the relationship between LV mass-voltage ratio with subsequent heart failure hospitalization (HHF) and mortality in CA. Patients with confirmed CA and comprehensive cardiovascular magnetic resonance (CMR) and EKG exams were included. CMR-derived LV mass was indexed to body surface area. EKG voltage was assessed using Sokolow, Cornell, and Limb-voltage criteria. The optimal LV mass-voltage ratio for predicting outcomes was determined using receiver operating characteristic curve analysis. The relationship between LV mass-voltage ratio and HHF was assessed using Cox proportional hazards analysis adjusting for significant covariates. A total of 85 patients (mean 69 ± 11 years, 22% female) were included, 42 with transthyretin and 43 with light chain CA. At a median of 3.4-year follow-up, 49% of patients experienced HHF and 60% had died. In unadjusted analysis, Cornell LV mass-voltage ratio was significantly associated with HHF (HR, 1.05; 95% CI 1.02-1.09, p = 0.001) and mortality (HR, 1.05; 95% CI 1.02-1.07, p = 0.001). Using ROC curve analysis, the optimal cutoff value for Cornell LV mass-voltage ratio to predict HHF was 6.7 gm/m2/mV. After adjusting for age, NYHA class, BNP, ECV, and LVEF, a Cornell LV mass-voltage ratio > 6.7 gm/m2/mV was significantly associated with HHF (HR 2.25, 95% CI 1.09-4.61; p = 0.03) but not mortality. Indexed LV mass-voltage ratio is associated with subsequent HHF and may be a useful prognostic marker in cardiac amyloidosis.
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Slivnick et al. (2020) conducted a cohort in Cardiac amyloidosis (n=85). Cornell LV mass-voltage ratio > 6.7 gm/m2/mV vs. Cornell LV mass-voltage ratio ≤ 6.7 gm/m2/mV was evaluated on Heart failure hospitalization (HHF) (HR 2.25, 95% CI 1.09-4.61, p=0.03). A Cornell LV mass-voltage ratio > 6.7 gm/m2/mV was significantly associated with an increased risk of heart failure hospitalization (HR 2.25) in patients with cardiac amyloidosis.
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