title: Prognostic value of fragmented QRS in cardiac AL amyloidosis.
abstract: BACKGROUND
  In light-chain (AL) cardiac amyloidosis, the 12-lead electrocardiogram (ECG) reflects myocardial amyloid infiltration with low limb voltages, pseudoinfarction patterns, and conduction abnormalities. Moreover, it is not unusual to see "aspecific" QRS complex abnormalities, such as notches and RsR' pattern in the absence of QRS prolongation, i.e. a fragmentation of QRS complexes (fQRS), that has been associated with myocardial scars and prognosis. Since cardiomyocyte damage and interstitial fibrosis are associated with cardiac amyloid deposition, aim of the present study was to analyze the prevalence and the potential prognostic value of fQRS in patients with cardiac amyloidosis.
  
  
  METHODS
  We enrolled 375 consecutive untreated patients in whom a first AL amyloidosis diagnosis was concluded between 2008 and 2010, 264 with and 111 without heart involvement. Patients with a positive history of coronary disease were excluded from the analysis.
  
  
  RESULTS
  The prevalence of fQRS was significantly higher in patients with cardiac AL amyloidosis (28.5% vs. 11.7%; p=0.0008). After a median follow-up of 561 days, Kaplan-Meier survival analysis revealed a significantly higher mortality in the fQRS group when compared with the "normal" QRS group (p=0.0008). No association was found between the presence of fQRS and the duration of PQ, QRS, and QTc intervals, the presence of peripheral low voltages or pseudonecrosis, NT-proBNP serum levels or cardiac wall thickness.
  
  
  CONCLUSIONS
  In patients with cardiac AL amyloidosis, the presence of fQRS at diagnosis has an independent prognostic value. Such a simple and cheap analysis in patients' diagnostic work-up may improve diagnosis and prognostic stratification.
authors: Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Pavia, Italy. stefano.perlini@unipv.it
authors: Stefano
authors: S
authors: Perlini
authors: Francesco
authors: F
authors: Salinaro
authors: Francesco
authors: F
authors: Cappelli
authors: Federico
authors: F
authors: Perfetto
authors: Franco
authors: F
authors: Bergesio
authors: Alessio
authors: A
authors: Alogna
authors: Roberta
authors: R
authors: Mussinelli
authors: Michele
authors: M
authors: Boldrini
authors: Ambra
authors: A
authors: Raimondi
authors: Francesco
authors: F
authors: Musca
authors: Giovanni
authors: G
authors: Palladini
authors: Giampaolo
authors: G
authors: Merlini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis