Left ventricular posterior wall thickness independently predicts the possibility of light-chain cardiac amyloidosis in hospitalized heart failure patients with monoclonal gammopathies.

BACKGROUND: Early screening for cardiac light-chain amyloidosis (CA-AL) remains a diagnostic challenge due to its nonspecific clinical features. This study aimed to assess whether the results of routine cardiology examinations could predict CA-AL in hospitalized heart failure patients with monoclonal gammopathies.

METHODS: After strict filtering, 187 consecutive patients with heart failure and comorbid monoclonal gammopathy were prospectively enrolled from the Department of Cardiology. All patients were referred to the hematologists for further evaluation of suspected cardiac amyloidosis. The cohort consisted of 127 patients with CA-AL, 34 with multiple myeloma (MM), and 26 with monoclonal gammopathy of undetermined significance (MGUS). Comprehensive laboratory and imaging data were systematically collected for each patient.

RESULTS: Our results indicated that CA-AL patients exhibited significantly lower left ventricular ejection fractions (EF), proteinuria, and serum creatinine levels, as well as substantially higher cardiac troponin T (cTn-T), free-light chain (FLC) λ, and displayed differences in serum free-light chain (dFLC) levels compared to MM patients. Compared with MM and MGUS patients, CA-AL patients showed consistently increased thicknesses of the interventricular septum and left ventricular posterior wall (LVPW). Univariate and bidirectional logistic regression analysis revealed that thicker LVPW and higher dFLC were significant risk factors for CA-AL. Receiver operating characteristic (ROC) curve analysis demonstrated that the LVPW thickness [area under the curve (AUC) = 0.798, 95% confidence interval (CI) 0.728-0.868] yielded a better AUC than dFLC (AUC = 0.661, 95% CI 0.569-0.754), and combining LVPW with dFLC did not significantly increase diagnostic outcome as compared with LVPW alone.

CONCLUSIONS: These findings suggest that LVPW thickness effectively predicts CA-AL in hospitalized heart failure patients with monoclonal gammopathies, thereby providing valuable insights into the diagnostic process for CA-AL.