ArticleEchocardiography (Mount Kisco, N.Y.)2026
LVH-Voltage Discordance and Myocardial Dysfunction in Wild-Type Transthyretin Cardiomyopathy: A Prospective Cohort Study.
Article in Echocardiography (Mount Kisco, N.Y.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM), increased left ventricular wall thickness reflects amyloid infiltration rather than myocyte hypertrophy, and QRS voltage may not rise proportionally. Whether this electrical-anatomical discordance marks myocardial dysfunction and adverse outcomes within established disease is uncertain.
methodsWe prospectively enrolled 220 consecutive patients with newly diagnosed wtATTR-CM in a single-centre cohort. LVH-voltage discordance was defined as maximum LV wall thickness ≥12 mm with a Sokolow-Lyon voltage < 3.5 mV. The primary outcome was absolute global longitudinal strain (GLS); secondary outcomes included impaired GLS (< 16%), serial GLS change, and clinical events.
resultsDiscordance was present in 41.8%. Absolute GLS was lower with discordance (13.4 ± 2.8% vs. 17.3 ± 3.5%), including after multivariable adjustment (β -2.21, 95% CI -3.04 to -1.39; p< 0.001), without interaction by rhythm (p = 0.52). Impaired GLS was more prevalent (81.5% vs. 35.2%; adjusted prevalence ratio 1.66, 95% CI 1.28-2.15). The continuous QRS amplitude-to-wall-thickness index correlated with absolute GLS (ρ = 0.35; p< 0.001). Over a median 16.0 months, discordance was associated with cardiovascular death or first heart failure hospitalization (adjusted HR 3.88, 95% CI 1.43-10.52) and first heart failure hospitalization (adjusted HR 3.48, 95% CI 1.08-11.18); mortality estimates were imprecise. Among 142 patients with serial imaging, adjusted annual GLS decline was greater with discordance (-0.65 vs. -0.31 percentage points/year).
conclusionsIn established wtATTR-CM, LVH-voltage discordance was associated with worse baseline GLS, a less favorable longitudinal GLS trajectory, and HF-related outcomes. It may provide a simple marker for within-disease phenotyping, but these findings require external validation.
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