Progression and Prognostic Significance of Electrocardiographic Findings in Patients with Cardiac Amyloidosis

AIMS: This study aimed to evaluate the change of the main electrocardiographic (ECG) characteristics and their prognostic role across the main subtypes of cardiac amyloidosis light-chain amyloidosis (AL) and hereditary (ATTRv) and wild-type transthyretin amyloidosis (ATTRwt). METHODS AND RESULTS: This multicentre, retrospective study was performed in six referral centres for cardiac amyloidosis. Clinical and ECG data were collected at the first and last evaluations. Three hundred fifty-six patients were included (AL, n = 105; ATTRv, n = 50; ATTRwt, n = 201). The median age was 76 (67-81) years, and 271 (74%) were men. At baseline, patients with ATTRwt showed a higher prevalence of conduction abnormalities compared with those with AL first-degree atrioventricular block, n = 51 (40%) vs. n = 13 (34%), P 0.05). The adjusted odds ratios for the development of right bundle branch block were higher in AL compared with ATTRwt [odds ratio 4.7 (95% confidence interval 1.5-15), P < 0.05. QRS duration at baseline remained independently associated with patient survival in the overall population even after adjustment for relevant clinical variables hazard ratio 1.78 (95% confidence interval 1.13-2.8), P < 0.01. CONCLUSIONS: The progression of the ECG abnormalities seems similar across amyloidosis subtypes. QRS duration could be a marker of more advanced disease.