Noninvasive Diagnosis of Biopsy-Proven Cardiac Amyloidosis

Joseph E. Rahman, Emelie F. Helou, Ramona Gelzer-Bell, Richard E. Thompson, Chih Kuo, E. Rene Rodriguez, Joshua Hare, Kenneth L. Baughman, Edward K. Kasper

Research output: Contribution to journalArticle

200 Citations (Scopus)

Abstract

OBJECTIVES: This study analyzed the utility of electrocardiographic (ECG) and echocardiographic findings in the diagnosis of amyloidosis proven by endomyocardial biopsy. BACKGROUND: Cardiac amyloidosis is associated with characteristic ECG and echocardiographic changes, yet each finding alone is relatively nonspecific. A combination of noninvasive prognostic parameters would be desirable for this tissue-based diagnosis. METHODS: We performed an analysis of 196 consecutive patients referred for endomyocardial biopsy because of clinical suspicion of cardiac amyloidosis. The diagnosis was confirmed in 58 patients (29%). The ECGs, echocardiograms, and right heart hemodynamic data were reviewed to determine which findings strongly correlate with the diagnosis. These findings were then used to build multivariate logistic regression models that predict the log-odds of having cardiac amyloidosis. RESULTS: The univariate analysis showed that low-voltage and pseudo-infarction patterns on the ECG and increased myocardial thickness and speckled-appearing myocardium on the echocardiogram were associated with biopsy-proven cardiac amyloidosis (each p < 0.01). In multivariate logistic regression models, a combination of a low voltage and measures of myocardial thickness produced the most statistically useful models. For instance, one model showed that if a low voltage was present and interventricular septal thickness is >1.98 cm, the diagnosis of cardiac amyloidosis could be made with a sensitivity of 72% and a specificity of 91%. In this model, the positive predictive and negative predictive values were 79% and 88%, respectively. CONCLUSIONS: In patients with suspected cardiac amyloidosis, a combination of noninvasive parameters - namely, a low voltage and increased intraventricular septal thickness - is a useful diagnostic tool.

Original languageEnglish
Pages (from-to)410-415
Number of pages6
JournalJournal of the American College of Cardiology
Volume43
Issue number3
DOIs
StatePublished - Feb 4 2004
Externally publishedYes

Fingerprint

Amyloidosis
Biopsy
Logistic Models
Infarction
Myocardium
Electrocardiography
Hemodynamics

Keywords

  • CHF
  • Congestive heart failure
  • ECG
  • Electrocardiogram/electrocardiographic
  • Interventricular septal
  • IVS
  • Left ventricular
  • LV
  • New York Heart Association
  • NYHA
  • Odds ratio
  • OR

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Rahman, J. E., Helou, E. F., Gelzer-Bell, R., Thompson, R. E., Kuo, C., Rodriguez, E. R., ... Kasper, E. K. (2004). Noninvasive Diagnosis of Biopsy-Proven Cardiac Amyloidosis. Journal of the American College of Cardiology, 43(3), 410-415. https://doi.org/10.1016/j.jacc.2003.08.043

Noninvasive Diagnosis of Biopsy-Proven Cardiac Amyloidosis. / Rahman, Joseph E.; Helou, Emelie F.; Gelzer-Bell, Ramona; Thompson, Richard E.; Kuo, Chih; Rodriguez, E. Rene; Hare, Joshua; Baughman, Kenneth L.; Kasper, Edward K.

In: Journal of the American College of Cardiology, Vol. 43, No. 3, 04.02.2004, p. 410-415.

Research output: Contribution to journalArticle

Rahman, JE, Helou, EF, Gelzer-Bell, R, Thompson, RE, Kuo, C, Rodriguez, ER, Hare, J, Baughman, KL & Kasper, EK 2004, 'Noninvasive Diagnosis of Biopsy-Proven Cardiac Amyloidosis', Journal of the American College of Cardiology, vol. 43, no. 3, pp. 410-415. https://doi.org/10.1016/j.jacc.2003.08.043
Rahman JE, Helou EF, Gelzer-Bell R, Thompson RE, Kuo C, Rodriguez ER et al. Noninvasive Diagnosis of Biopsy-Proven Cardiac Amyloidosis. Journal of the American College of Cardiology. 2004 Feb 4;43(3):410-415. https://doi.org/10.1016/j.jacc.2003.08.043
Rahman, Joseph E. ; Helou, Emelie F. ; Gelzer-Bell, Ramona ; Thompson, Richard E. ; Kuo, Chih ; Rodriguez, E. Rene ; Hare, Joshua ; Baughman, Kenneth L. ; Kasper, Edward K. / Noninvasive Diagnosis of Biopsy-Proven Cardiac Amyloidosis. In: Journal of the American College of Cardiology. 2004 ; Vol. 43, No. 3. pp. 410-415.
@article{3c12bf57cd204db5be8c09d7c5dadc21,
title = "Noninvasive Diagnosis of Biopsy-Proven Cardiac Amyloidosis",
abstract = "OBJECTIVES: This study analyzed the utility of electrocardiographic (ECG) and echocardiographic findings in the diagnosis of amyloidosis proven by endomyocardial biopsy. BACKGROUND: Cardiac amyloidosis is associated with characteristic ECG and echocardiographic changes, yet each finding alone is relatively nonspecific. A combination of noninvasive prognostic parameters would be desirable for this tissue-based diagnosis. METHODS: We performed an analysis of 196 consecutive patients referred for endomyocardial biopsy because of clinical suspicion of cardiac amyloidosis. The diagnosis was confirmed in 58 patients (29{\%}). The ECGs, echocardiograms, and right heart hemodynamic data were reviewed to determine which findings strongly correlate with the diagnosis. These findings were then used to build multivariate logistic regression models that predict the log-odds of having cardiac amyloidosis. RESULTS: The univariate analysis showed that low-voltage and pseudo-infarction patterns on the ECG and increased myocardial thickness and speckled-appearing myocardium on the echocardiogram were associated with biopsy-proven cardiac amyloidosis (each p < 0.01). In multivariate logistic regression models, a combination of a low voltage and measures of myocardial thickness produced the most statistically useful models. For instance, one model showed that if a low voltage was present and interventricular septal thickness is >1.98 cm, the diagnosis of cardiac amyloidosis could be made with a sensitivity of 72{\%} and a specificity of 91{\%}. In this model, the positive predictive and negative predictive values were 79{\%} and 88{\%}, respectively. CONCLUSIONS: In patients with suspected cardiac amyloidosis, a combination of noninvasive parameters - namely, a low voltage and increased intraventricular septal thickness - is a useful diagnostic tool.",
keywords = "CHF, Congestive heart failure, ECG, Electrocardiogram/electrocardiographic, Interventricular septal, IVS, Left ventricular, LV, New York Heart Association, NYHA, Odds ratio, OR",
author = "Rahman, {Joseph E.} and Helou, {Emelie F.} and Ramona Gelzer-Bell and Thompson, {Richard E.} and Chih Kuo and Rodriguez, {E. Rene} and Joshua Hare and Baughman, {Kenneth L.} and Kasper, {Edward K.}",
year = "2004",
month = "2",
day = "4",
doi = "10.1016/j.jacc.2003.08.043",
language = "English",
volume = "43",
pages = "410--415",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "3",

}

TY - JOUR

T1 - Noninvasive Diagnosis of Biopsy-Proven Cardiac Amyloidosis

AU - Rahman, Joseph E.

AU - Helou, Emelie F.

AU - Gelzer-Bell, Ramona

AU - Thompson, Richard E.

AU - Kuo, Chih

AU - Rodriguez, E. Rene

AU - Hare, Joshua

AU - Baughman, Kenneth L.

AU - Kasper, Edward K.

PY - 2004/2/4

Y1 - 2004/2/4

N2 - OBJECTIVES: This study analyzed the utility of electrocardiographic (ECG) and echocardiographic findings in the diagnosis of amyloidosis proven by endomyocardial biopsy. BACKGROUND: Cardiac amyloidosis is associated with characteristic ECG and echocardiographic changes, yet each finding alone is relatively nonspecific. A combination of noninvasive prognostic parameters would be desirable for this tissue-based diagnosis. METHODS: We performed an analysis of 196 consecutive patients referred for endomyocardial biopsy because of clinical suspicion of cardiac amyloidosis. The diagnosis was confirmed in 58 patients (29%). The ECGs, echocardiograms, and right heart hemodynamic data were reviewed to determine which findings strongly correlate with the diagnosis. These findings were then used to build multivariate logistic regression models that predict the log-odds of having cardiac amyloidosis. RESULTS: The univariate analysis showed that low-voltage and pseudo-infarction patterns on the ECG and increased myocardial thickness and speckled-appearing myocardium on the echocardiogram were associated with biopsy-proven cardiac amyloidosis (each p < 0.01). In multivariate logistic regression models, a combination of a low voltage and measures of myocardial thickness produced the most statistically useful models. For instance, one model showed that if a low voltage was present and interventricular septal thickness is >1.98 cm, the diagnosis of cardiac amyloidosis could be made with a sensitivity of 72% and a specificity of 91%. In this model, the positive predictive and negative predictive values were 79% and 88%, respectively. CONCLUSIONS: In patients with suspected cardiac amyloidosis, a combination of noninvasive parameters - namely, a low voltage and increased intraventricular septal thickness - is a useful diagnostic tool.

AB - OBJECTIVES: This study analyzed the utility of electrocardiographic (ECG) and echocardiographic findings in the diagnosis of amyloidosis proven by endomyocardial biopsy. BACKGROUND: Cardiac amyloidosis is associated with characteristic ECG and echocardiographic changes, yet each finding alone is relatively nonspecific. A combination of noninvasive prognostic parameters would be desirable for this tissue-based diagnosis. METHODS: We performed an analysis of 196 consecutive patients referred for endomyocardial biopsy because of clinical suspicion of cardiac amyloidosis. The diagnosis was confirmed in 58 patients (29%). The ECGs, echocardiograms, and right heart hemodynamic data were reviewed to determine which findings strongly correlate with the diagnosis. These findings were then used to build multivariate logistic regression models that predict the log-odds of having cardiac amyloidosis. RESULTS: The univariate analysis showed that low-voltage and pseudo-infarction patterns on the ECG and increased myocardial thickness and speckled-appearing myocardium on the echocardiogram were associated with biopsy-proven cardiac amyloidosis (each p < 0.01). In multivariate logistic regression models, a combination of a low voltage and measures of myocardial thickness produced the most statistically useful models. For instance, one model showed that if a low voltage was present and interventricular septal thickness is >1.98 cm, the diagnosis of cardiac amyloidosis could be made with a sensitivity of 72% and a specificity of 91%. In this model, the positive predictive and negative predictive values were 79% and 88%, respectively. CONCLUSIONS: In patients with suspected cardiac amyloidosis, a combination of noninvasive parameters - namely, a low voltage and increased intraventricular septal thickness - is a useful diagnostic tool.

KW - CHF

KW - Congestive heart failure

KW - ECG

KW - Electrocardiogram/electrocardiographic

KW - Interventricular septal

KW - IVS

KW - Left ventricular

KW - LV

KW - New York Heart Association

KW - NYHA

KW - Odds ratio

KW - OR

UR - http://www.scopus.com/inward/record.url?scp=0842330668&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0842330668&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2003.08.043

DO - 10.1016/j.jacc.2003.08.043

M3 - Article

VL - 43

SP - 410

EP - 415

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 3

ER -