DOI: 10.1161/jaha.125.043647 ISSN: 2047-9980

Noninvasive Characterization of Myocardial Diseases With Hypertrophic Phenotypes Using Integrated ECG/Echocardiographic Indices

Valentina Allegro, Linda Pagura, Aldostefano Porcari, Giulia Barbati, Simone Longhi, Beatrice Musumeci, Alberto Cipriani, Marco Canepa, Cristina Chimenti, Rosa Lillo, Francesca Graziani, Giacomo Bonacchi, Alessia Argiro, Mattia Zampieri, Chiara Chiti, Irene Ruotolo, Giacomo Tini, Laura De Michieli, Giulio Sinigiani, Gianluca Di Bella, Marianna Eleonora Labate, Virginia Eustachi, Alessio Cianci, Aniello Sammartino, Iacopo Olivotto, Elena Biagini, Gianfranco Sinagra, Marco Merlo, Francesco Cappelli
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Background

Indices reflecting the discordance between QRS complex voltages on ECG and left ventricular (LV) wall thickness or LV mass index on echocardiogram (echo) have enabled identification of cardiac amyloidosis (CA) among patients with hypertrophic hearts. However, this evidence comes from studies that have excluded patients with established hypertrophic cardiomyopathy (HCM) and Anderson‐Fabry disease (AFD). The aim of this study was to assess the performance of ECG/echo indices in characterizing adult patients with cardiomyopathies and hypertrophic phenotype.

Methods

This was an Italian retrospective, cross‐sectional, multicenter study. Data from ECGs and echo of consecutive adult patients with confirmed CA, HCM, and AFD, and an LV wall thickness >12 mm were analyzed to calculate different ECG/echo indices.

Results

Of the 1181 patients included (median age, 65 years; 69% men), 35.5% (n=416) had CA, 46.5% (n=594) had HCM, and 14.5% (n=171) had AFD. All ECG/echo indices were able to distinguish CA from other HCM and AFD ( P <0.001). The total QRS score/LV mass index was the best performing ECG/echo index for differentiating CA from other hypertrophic phenotypes (accuracy: 83%). The total QRS/maximum LV wall thickness was the best performing index in discriminating between the 3 cardiomyopathies (cutoff values of 6.21 versus 9.81 versus 11.47 in CA, HCM, AFD, respectively; P <0.001 for all comparisons).

Conclusions

ECG/echo indices, particularly total QRS/maximum LV wall thickness, may serve as easily accessible first‐line tools to differentiate CA from HCM and AFD. These findings may enable prompt recognition of patients with different cardiomyopathies in everyday clinical practice, both in community‐based centers and tertiary care facilities, and to orient subsequent diagnostic workup.

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