Comparative analysis of electrocardiographic patterns of ventricular hypertrophy in cardiac amyloidosis and other cardiomyopathies.

INTRODUCTION

The early identification of conditions that lead to increased myocardial wall thickness, such as transthyretin amyloid cardiomyopathy (ATTR-CM), severe aortic stenosis (AS), hypertrophic cardiomyopathy (HCM), and hypertensive heart disease (HHD), is challenging due to overlapping features. Delayed diagnosis can postpone appropriate treatment and worsen prognosis. This study aimed to evaluate the frequency of key electrocardiographic patterns in these conditions, with a specific emphasis on differentiating ATTR-CM from other causes of wall thickening.

METHODS

Electrocardiograms (ECGs) from the medical records of 400 patients over 60 years old were analyzed, divided into four groups (ATTR-CM, HCM, HHD, and AS) with confirmed diagnoses and septal thickening (≥12 mm). Specific electrocardiographic patterns, including left ventricular hypertrophy, left atrial enlargement, low voltage, pseudoinfarction, and left ventricular pressure overload, were assessed. Multiple chi-square tests with Bonferroni adjustment were used to detect significant differences between groups.

RESULTS

The Sokolow-Lyon criteria was absent in all ATTR-CM cases, compared to 13 % in other conditions (p = 0.001). Additionally, ATTR-CM showed a higher prevalence of low voltage (45 % vs. 18.3 %, p = 0.001) and pseudoinfarction pattern (32 % vs. 22 %, p = 0.007), but a lower prevalence of left atrial enlargement (8 % vs. 30 %, p = 0.005). Absence of the Sokolow criteria was the best predictor of ATTR-CM (sensitivity 100 %, NPV 100 %, PPV 27 %), followed by the presence of low voltage and pseudoinfarction.

CONCLUSIONS

Significant differences were observed in the prevalence of electrocardiographic patterns between ATTR-CM and other wall thickening phenotypes. These findings may aid in the early detection and diagnosis of ATTR-CM, allowing for more timely intervention.