| Objective: Amyloid cardiomyopathy is a group of infiltrative restrictive cardiomyopathy characterized by increased stiffness and decreased diastolic function of the ventricular wall and ventricular filling restriction with left heart failure or global heart failure.It is easy to miss diagnosis in clinic because its clinical manifestations are impaired activity tolerance,dyspnea,hepatomegaly,peritoneal effusion and systemic edema as the disease progresses.However,there is a mismatch between "electricity" and "structure" in the disease,that is,in the imaging examination such as echocardiography,the thickness of the wall is increased and the electrocardiogram is the low voltage change of the limb lead.The characteristics have clinical diagnostic significance for amyloidosis.This study was to investigate the diagnostic value and clinical value of the left ventricular hypertrophy combined with the limb lead low voltage in amyloidosis.Methods: Collected from November 2000 to November 2018,at the time of The First Affiliated Hospital Of Dalian Medical University Clinical diagnosis of amyloid cardiomyopathy,primary non obstructive hypertrophic cardiomyopathy,moderately severe aortic stenosis,and patients with hypertensive heart disease,eliminate fat,congenital heart disease,emphysema,skin edema,pleural effusion,a large number of pericardial effusion,pericarditis,hypothyroidism,simple ventricular septal thickening of basal parts and coronary heart disease(CHD),complete left bundle branch block,the left pneumothorax,left pleural effusion,lung or mediastinum tumor,on the left side of the pneumonia and chronic cor pulmonale patients,a total of 128 patients were selected.According to the disease,the patients were divided into the following five groups: the group 1 was diagnosed with amyloidosis cardiomyopathy(16 cases),the group 2 was diagnosed with non-obstructive hypertrophic cardiomyopathy(32 cases),the group 3was diagnosed with moderately severe primary patients with aortic stenosis(30 cases),the group 4 were diagnosed with hypertensive heart disease(30cases),the group 5suspected amyloidosis cardiomyopathy(20 cases).Group 1 was amyloid cardiomyopathy group,group 2,group 3 and group 4 were non-amyloid cardiomyopathy group,the group 5 was compared with the group 1 alone.All subjects had complete echocardiographic reports and standard 12-lead ECG results.Group 2,group 3 and group 4 were compared with group 1 respectively.The sensitivity,specificity,missed diagnosis rate,coincidence rate,misdiagnosis rate,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio were used as the criteria for the preliminary diagnosis of amyloid cardiomyopathy.Results:1.Group 1,Group 2,Group 3 and Group 4 had no statistical difference in age,sex,incidence of atrial fibrillation and diabetes mellitus(P >0.05).Compared with Group 2and Group 4,Group 1 had shorter course of disease,with statistical significance;Group4 had longer course than Group 3,with statistical significance.2.Except for the left atrial diameter,the other echocardiographic parameters and ECG parameters were statistically different among the four groups.In the degree of thickeness of the interventricular septum,the group 2 is present,the group 1 is the first;in the left ventricular posterior wall thickness,the group 1 is characterized by diffuse symmetry and significant thickening;the group 1 is relatively small,and the comparison of the left atrial diameter is basically the same among the 4 groups.In terms of left ventricular ejection fraction,the group 1 and the group 4 are slightly reduced compared with the group 2;the group 1 has limb lead low voltage and the abnormal Q wave ECG changes were significantly higher than other groups;the incidence of poor R wave in the chest lead was not statistically different among the four groups(P>0.05).3.The left ventricular hypertrophy combined with the limb lead low voltage as the preliminary criterion for the initial diagnosis of amyloidosis cardiomyopathy,diagnostic sensitivity,specificity,coincidence rate,missed diagnosis rate,misdiagnosis rate,positive predictive value,negative predictive value,positive likelihood The ratios of ratios to negatives were 81.3%,97.8%,95.4%,18.7%,2.2%,86.7%,96.8%,29,0.2,respectively.Conclusion:1.The low voltage of limb leads has a high incidence in amyloidosis,which is one ofthe clinical features of amyloidosis.2.The phenomenon of "electrical" and "structural" mismatches(echocardiography and other imaging examinations showed thickening of the ventricular wall,while the electrocardiogram showed lower voltage changes of the limb leads)was taken as a reliable indicator for the preliminary diagnosis of amyloidosis cardiomyopathy with left ventricular hypertrophy.Its sensitivity and positive predictive value are higher(>80%).It is helpful for the diagnosis of patients with high suspicion of amyloidosis cardiomyopathy in clinic and reduces the rate of missed diagnosis.In addition,the specificity and negative predictive value of this criterion are higher(both > 95%).It has good clinical practical value for excluding diagnosis and reducing the rate of misdiagnosis.3.The electrocardiogram abnormalities of amyloid cardiomyopathy include abnormal Q wave and poor increase of R wave in the precordial leads.These two changes are very common,but they are also common in other cardiac diseases with left ventricular hypertrophy(such as non-obstructive hypertrophic cardiomyopathy,moderate or severe aortic stenosis or hypertensive heart disease).Therefore,they lack the value of clinical diagnosis or differential diagnosis. |
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