Wild-type (senile) amyloidosis electrocardiogram
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Electrocardiogram
- EKG is one of the oldest, best described and most widely used cardiac diagnostic modalities worldwide. However, its use as diagnostic tool for ATTRwt-CA has likely lead to falsely reduced clinical suspicion and its underdiagnoses of the disease.
- This is largely from the “classical” teaching which dictates that cardiac amyloidosis is associated with low voltage
- In recent ATTRwt-CA studies, low voltage has been found to have poor independent sensitivity (~30%) for its diagnosis.
- There are numerous other EKG findings that are seen in patients with ATTRwt-CA but have low sensitivity and specificity for the disease because they are also common in age and comorbidities matched patient cohorts:
- Pseudoinfarct pattern
- Poor R-wave progression (
- Atrial fibrillation
- First degree AV block
- Nonspecific ST-T-wave abnormalities
- Left bundle branch block can be potentially useful to differentiate ATTRwt-CA and AL-CA.
- Voltage-to-mass ratio, calculated by sum of S wave in lead V1 plus R wave in lead V5 or V6 (SV1 + RV5 or V6) divided by the echocardiographic muscle cross-sectional area has been shown to have high sensitivity and specificity for ATTRwt-CA.