Electrocardiogram Characteristics and Prognostic Value in Light-Chain Amyloidosis: A Comparison With Cardiac Magnetic Resonance Imaging

Background: An electrocardiogram (ECG) is a simple and cheap non-invasive tool that shows various abnormalities and has prognostic value for patients with light-chain amyloidosis (AL). The present study aimed to explore the association between ECG characteristics and cardiac magnetic resonance (CMR)-detected amyloid burden and to investigate the prognostic value of ECG in AL amyloidosis.Methods: We prospectively enrolled 99 patients with AL amyloidosis (56 male patients; median age, 58 y). Detailed clinical information, 12-lead ECG, and CMR data were collected. All patients were followed up longitudinally, and the endpoint was all-cause mortality. ECG characteristics were analyzed and correlated with the degree of late gadolinium enhancement (LGE) and extracellular volume (ECV) by T1 mapping on CMR. The prognostic value of ECG characteristics was analyzed using Kaplan–Meier survival analysis and multivariate Cox regression.Results: During a median follow-up period of 33 months, 69 of the 99 patients died. Fragmented Q wave-R wave-S wave (QRS), pathological Q waves, the Sokolow index, QRS duration, and voltages were significantly associated with the extent of LGE, native T1, and ECV by CMR (p < 0.05). Fragmented QRS and Sokolow index showed independent prognostic value in AL amyloidosis (p = 0.001; p = 0.026, respectively). Fragmented QRS remained independent after adjusting for clinical values (hazard ratio: 2.034; 95% confidence interval: 1.148–3.603; p = 0.015). However, no ECG characteristics were independent predictors for prognosis in AL amyloidosis when LGE and ECV were included in the multivariate analysis.Conclusion: ECG abnormalities showed significant association with CMR indicators of amyloid burden. Fragmented QRS has an independent prognostic value in AL amyloidosis and could be used as an alternative marker when CMR is not available.

153 Fragmented QRS in athletes

Aims Fragmented QRS (fQRS), defined as the presence of additional peaks within the QRS complex (<120 ms) in at least two contiguous leads, was considered as a pattern of fibrosis. However, fQRS can also be detected during pre-participation cardiovascular screening. To assess determinants of fQRS in athletes of different sports. Methods and results Retrospective study conducted on 605 non-sedentary subjects undergoing pre-participation cardiovascular screening for competitive activity in six disciplines (athletics, football, cycling, swimming, basketball, and volleyball). All subjects underwent ECG for the search of fQRS and transthoracic echocardiography. Predictors of fQRS were investigated using multivariate logistic analysis adjusted for. fQRS was found in 47 of 605 subjects. On multivariate logistic analysis, fQRS was positively associated with age (OR: 1.03; 95% CI: 1.01–1.05), male sex (OR: 0.35; 95% CI: 0.13–0.94), whereas no association with sport discipline was observed (0.91; 0.73–1.12). When echocardiographic parameters were considered, fQRS was associated with cardiac mass index (OR: 1.02; 95% CI: 1.00–1.03) and E wave (OR: 0.98; 95% CI: 0.96–0.99). Conclusions At pre-participation cardiovascular screening, the fQRS finding increases with age, is more frequent in males, and seems to be independent from practiced sport. Furthermore, fQRS in athletes appears to be associated with parameters of physiological hypertrophy (LV cardiac mass index and diastolic function).