Indexed left ventricular mass to QRS voltage ratio is associated with heart failure hospitalizations in patients with ca
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ORIGINAL PAPER
Indexed left ventricular mass to QRS voltage ratio is associated with heart failure hospitalizations in patients with cardiac amyloidosis Jeremy A. Slivnick1 · Alexander L. Wallner1 · Ajay Vallakati1 · Vien T. Truong2 · Wojciech Mazur2 · Mohamed B. Elamin3 · Matthew S. Tong1 · Subha V. Raman4 · Karolina M. Zareba1 Received: 3 September 2020 / Accepted: 5 October 2020 © The Author(s) 2020
Abstract In cardiac amyloidosis (CA), amyloid infiltration results in increased left ventricular (LV) mass disproportionate to electrocardiographic (EKG) voltage. We assessed the relationship between LV mass–voltage ratio with subsequent heart failure hospitalization (HHF) and mortality in CA. Patients with confirmed CA and comprehensive cardiovascular magnetic resonance (CMR) and EKG exams were included. CMR-derived LV mass was indexed to body surface area. EKG voltage was assessed using Sokolow, Cornell, and Limb–voltage criteria. The optimal LV mass–voltage ratio for predicting outcomes was determined using receiver operating characteristic curve analysis. The relationship between LV mass–voltage ratio and HHF was assessed using Cox proportional hazards analysis adjusting for significant covariates. A total of 85 patients (mean 69 ± 11 years, 22% female) were included, 42 with transthyretin and 43 with light chain CA. At a median of 3.4-year follow-up, 49% of patients experienced HHF and 60% had died. In unadjusted analysis, Cornell LV mass–voltage ratio was significantly associated with HHF (HR, 1.05; 95% CI 1.02–1.09, p = 0.001) and mortality (HR, 1.05; 95% CI 1.02–1.07, p = 0.001). Using ROC curve analysis, the optimal cutoff value for Cornell LV mass–voltage ratio to predict HHF was 6.7 gm/m2/mV. After adjusting for age, NYHA class, BNP, ECV, and LVEF, a Cornell LV mass–voltage ratio > 6.7 gm/m2/mV was significantly associated with HHF (HR 2.25, 95% CI 1.09–4.61; p = 0.03) but not mortality. Indexed LV mass–voltage ratio is associated with subsequent HHF and may be a useful prognostic marker in cardiac amyloidosis. Keywords Cardiac amyloidosis · Electrocardiography · Cardiac MRI · Cardiomyopathy · Heart failure Abbreviations CA Cardiac amyloid SCT Stem cell transplantation LVH Left ventricular hypertrophy HF Heart failure HHF Hospitalization for heart failure EKG Electrocardiogram LV Left ventricle * Karolina M. Zareba [email protected] 1
CMR Cardiovascular magnetic resonance Tc-PyP Technetium pyrophosphate BNP B-type natriuretic peptide GFR Glomerular filtration rate SSFP Steady state free precession RV Right ventricle ECV Extracellular volume SD Standard deviation ANOVA Analysis of variance ROC Receiver operating characteristic EF Ejection fraction NYHA New York Heart Association LGE Late gadolinium enhancement
Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 473 W 12th Ave, Suite 200, Columbus, OH 43210, USA
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Division of Cardiology, The Christ Hospital Health Network, Cincinnati, OH, USA
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Division of Cardiovascu
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