Signal-averaged electrocardiography in patients with AL (primary) amyloidosis.
One hundred thirty-three patients with biopsy-proven AL amyloidosis were studied with echocardiography, Holter recording, 12-lead electrocardiography, and signal-averaged electrocardiograms. Features from these tests were analyzed in relation to their effect on mortality. Late potentials were more frequent in patients with echocardiographic evidence of cardiac amyloidosis (31%) compared with patients with normal echocardiograms (9%, p < 0.003). One hundred six of the 133 patients died during follow-up, of which 34 were nonsudden cardiac deaths and 33 were sudden deaths. Abnormal echocardiograms and signal-averaged electrocardiograms were each predictive of all-cause cardiac death (p < 0.0001 ) and sudden cardiac death (p < 0.0001). Abnormal signal-averaged electrocardiograms were also independently predictive of sudden death in the subgroup of patients with an abnormal echocardiogram (p < 0.05). Thus late potentials are predictive of sudden death in patients with AL amyloidosis and provide independent prognostic information in patients with echocardiographic evidence of amyloid involvement.
Dubrey
S W
SW
Division of Cardiology, Boston University School of Medicine, MA, USA.
Bilazarian
S
S
LaValley
M
M
Reisinger
J
J
Skinner
M
M
Falk
R H
RH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008564:Membrane Potentials; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012815:Signal Processing, Computer-Assisted; D014463:Ultrasonography