A multi-modal diagnostic model improves detection of cardiac amyloidosis among patients with diagnostic confirmation by cardiac biopsy.
Am Heart J
; 232: 137-145, 2021 02.
Article
en En
| MEDLINE
| ID: mdl-33212046
ABSTRACT
BACKGROUND:
Timely recognition of cardiac amyloidosis is clinically important, but the diagnosis is frequently delayed.OBJECTIVES:
We sought to identify a multi-modality approach with the highest diagnostic accuracy in patients evaluated by cardiac biopsy, the diagnostic gold standard.METHODS:
Consecutive patients (Nâ¯=â¯242) who underwent cardiac biopsy for suspected amyloidosis within an 18-year period were retrospectively identified. Cardiac biomarker, ECG, and echocardiography results were examined for correlation with biopsy-proven disease. A prediction model for cardiac amyloidosis was derived using multivariable logistic regression.RESULTS:
The overall cohort was characterized by elevated BNP (median 727â¯ng/mL), increased left ventricular wall thickness (IWT; median 1.7â¯cm), and reduced voltage-to-mass ratio (median 0.06â¯mm/[g/m2]). One hundred and thirteen patients (46%) had either light chain (nâ¯=â¯53) or transthyretin (nâ¯=â¯60) amyloidosis by cardiac biopsy. A prediction model including age, relative wall thickness, left atrial pressure by E/e', and low limb lead voltage (<0.5â¯mV) showed good discrimination for cardiac amyloidosis with an optimism-corrected c-index of 0.87 (95% CI 0.83-0.92). The diagnostic accuracy of this model (79% sensitivity, 84% specificity) surpassed that of traditional screening parameters, such as IWT in the absence of left ventricular hypertrophy on ECG (98% sensitivity, 20% specificity) and IWT with low limb lead voltage (49% sensitivity, 91% specificity).CONCLUSION:
Among patients with an advanced infiltrative cardiomyopathy phenotype, traditional biomarker, ECG, and echocardiography-based screening tests have limited individual diagnostic utility for cardiac amyloidosis. A prediction algorithm including age, relative wall thickness, E/e', and low limb lead voltage improves the detection of cardiac biopsy-proven disease.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Neuropatías Amiloides Familiares
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Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas
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Cardiomiopatías
Tipo de estudio:
Diagnostic_studies
/
Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
Am Heart J
Año:
2021
Tipo del documento:
Article