Please use this identifier to cite or link to this item:
http://hdl.handle.net/1942/39435
Title: | Electrical Dyssynchrony in Cardiac Amyloidosis: Prevalence, Predictors, Clinical Correlates, and Outcomes | Authors: | MARTENS, Pieter Hanna, Mazen Valent, Jason MULLENS, Wilfried Ives, Lauren Kwon, Debbie H. Rickard, John Tang, W. H. Wilson |
Issue Date: | 2022 | Publisher: | CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS | Source: | JOURNAL OF CARDIAC FAILURE, 28 (12) , p. 1664 -1672 | Abstract: | Background: Conduction-system involvement in cardiac amyloidosis (CA) is common. The prevalence, clinical correlates and impact on outcome related to ventricular electrical dyssynchrony in CA remain insufficiently elucidated. Methods: Data from a prospectively maintained registry of patients with CA diagnosed in the Cleveland Clinic's amyloidosis clinic was used to determine the frequency of electrical dyssynchrony (defined as a QRS > 130 msec). The relation with the clinical profile and clinical outcome was assessed. To determine the impact of hypertrophy on QRS prolongation, a QRSmatched cohort without CA was used for comparison of cardiac magnetic resonance imaging. Results: A total of 1140 patients with CA (39% AL, 61% TTR) were evaluated, of whom 230 (20%) had electrical dyssynchrony. The type of conduction block was predominantly a right bundle branch block (BBB, 48%) followed by left BBB (35%) and intraventricular conduction delay (17%). Presence of transthyretin amyloidosis (ATTR-CA), older age, male gender, white race, and coronary artery disease were independently (P< 0.05 for all) associated with electrical dyssynchrony, and patients were more commonly prescribed a mineralocorticoid receptor antagonist. In ATTR-CA, specifically, every increase in ATTR-CA disease stage was associated with a 1.55-fold (1.23-1.95; P< 0.001) increased odds for electrical dyssynchrony. In a subset of patients with CA who underwent cardiac magnetic resonance imaging (n = 41), left ventricular mass index was unrelated to the QRS duration (r = 0.187; P = 0.283) in CA, in contrast to a nonCA QRS-matched cohort (r = 0.397; P< 0.001). Patients with electrical dyssynchrony were more symptomatic at initial presentation, as illustrated by a higher New York Heart Association class (P= 0.041). During a median follow-up of 462 days (IQR:138-996 days), a higher proportion of patients with electrical dyssynchrony died from all-cause death (P= 0.037) or developed a permanent pacing indication (3% vs 10.4%; P< 0.001) during follow-up. Conclusion: Electrical dyssynchrony is common in CA, especially in ATTR-CA, and is associated with worse functional status and clinical outcome. Given the high rate of permanent pacing indications at follow-up, additional studies are necessary to determine the best monitoring and pacing strategies in CA. (J Cardiac Fail 2022;28:1664-1672) | Notes: | Martens, P (corresponding author), Cleveland Clin, Heart Vasc & Thorac Inst, Dept Cardiovasc Med, Cleveland, OH 44195 USA.; Martens, P (corresponding author), Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium.; Martens, P (corresponding author), Univ Hasselt, Hasselt, Belgium. pieter_martens@icloud.com |
Keywords: | Cardiac amyloidosis;Cardiac amyloidosis;electrical dyssynchrony;electrical dyssynchrony;disease severity;disease severity;natural history;natural history | Document URI: | http://hdl.handle.net/1942/39435 | ISSN: | 1071-9164 | e-ISSN: | 1532-8414 | DOI: | 10.1016/j.cardfail.2022.07.046 | ISI #: | 000905073900004 | Rights: | 2022 Elsevier Inc. All rights reserved | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
Electrical Dyssynchrony in Cardiac Amyloidosis_ Prevalence, Predictors, Clinical Correlates, and Outcomes.pdf Restricted Access | Published version | 789.47 kB | Adobe PDF | View/Open Request a copy |
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.