Prognostic Significance of Holter Monitor Findings in Patients With Light Chain Amyloidosis

Surbhi Sidana, Nidhi Tandon, Peter A. Brady, Martha Grogan, Morie Gertz, Angela Dispenzieri, Grace D Lin, David M Dingli, Francis K. Buadi, Martha Lacy, Prashant Kapoor, Wilson Gonsalves, Eli Muchtar, Rahma Warsame, Shaji K Kumar, Taxiarchis Kourelis

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Abstract

Objective: To evaluate the prognostic impact of Holter findings in patients with light chain amyloidosis. Patients and Methods: We evaluated 239 patients in whom light chain amyloidosis was diagnosed from January 1, 2010, through December 31, 2015, who underwent 24-hour Holter monitoring. Results: Holter testing was done before stem cell transplant evaluation in 183 of the 239 patients (76.6%) and at diagnosis in 50 (20.9%). Holter findings were nonsustained ventricular tachycardia (NSVT) in 60 patients (25.1%), ventricular couplets in 103 (43.1)%, accelerated idioventricular rhythm in 32 (13.4%), and atrial fibrillation (AF) in 18 (7.5%). Overall survival (OS) at 3 and 6 months after Holter monitoring in patients with AF vs without AF was 78% (95% CI, 54%-91%) vs 96% (95% CI, 92%-98%) (P=.002) and 61% (95% CI, 38%-80%) vs 92% (95% CI, 87%-95%), (P<.001), respectively. In patients with and without NSVT, 3- and 6-month OS after Holter testing was 90% (95% CI, 80%-94%) vs 96% (95% CI, 91%-98%) (P=.12) and 77% (95% CI, 64%-85%) vs 94% (95% CI, 89%-97%) (P<.001), respectively. For patients with and without ventricular couplets, 3- and 6-month OS was 94% (95% CI, 88%-97%) vs 94% (95% CI, 89%-97%) (P=.98) and 84% (95% CI, 75%-89%) vs 94% (95% CI, 89%-97%) (P=.01), respectively. Atrial fibrillation (hazard ratio, 2.5; 95% CI, 1.2-5.0; P=.02) and NSVT (hazard ratio, 2.0; 95% CI, 1.1-3.5; P=.02) were independent predictors for OS after accounting for age and Mayo stage. For patients undergoing routine testing before stem cell transplant, AF (P=.002) and NSVT (P=.02) were associated with inferior OS at 6 months but did not retain statistical significance after adjusting for Mayo stage (P=.10 and P=.54, respectively). Conclusion: Atrial fibrillation and NSVT on 24-hour Holter monitoring are associated with inferior short-term OS outcomes but do not impact peritransplant mortality.

Original languageEnglish (US)
JournalMayo Clinic Proceedings
DOIs
StatePublished - Jan 1 2019

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Amyloidosis
Light
Atrial Fibrillation
Ventricular Tachycardia
Ambulatory Electrocardiography
Survival
Accelerated Idioventricular Rhythm
Stem Cells
Transplants
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{84417128fda443a897bf749e4f8e3392,
title = "Prognostic Significance of Holter Monitor Findings in Patients With Light Chain Amyloidosis",
abstract = "Objective: To evaluate the prognostic impact of Holter findings in patients with light chain amyloidosis. Patients and Methods: We evaluated 239 patients in whom light chain amyloidosis was diagnosed from January 1, 2010, through December 31, 2015, who underwent 24-hour Holter monitoring. Results: Holter testing was done before stem cell transplant evaluation in 183 of the 239 patients (76.6{\%}) and at diagnosis in 50 (20.9{\%}). Holter findings were nonsustained ventricular tachycardia (NSVT) in 60 patients (25.1{\%}), ventricular couplets in 103 (43.1){\%}, accelerated idioventricular rhythm in 32 (13.4{\%}), and atrial fibrillation (AF) in 18 (7.5{\%}). Overall survival (OS) at 3 and 6 months after Holter monitoring in patients with AF vs without AF was 78{\%} (95{\%} CI, 54{\%}-91{\%}) vs 96{\%} (95{\%} CI, 92{\%}-98{\%}) (P=.002) and 61{\%} (95{\%} CI, 38{\%}-80{\%}) vs 92{\%} (95{\%} CI, 87{\%}-95{\%}), (P<.001), respectively. In patients with and without NSVT, 3- and 6-month OS after Holter testing was 90{\%} (95{\%} CI, 80{\%}-94{\%}) vs 96{\%} (95{\%} CI, 91{\%}-98{\%}) (P=.12) and 77{\%} (95{\%} CI, 64{\%}-85{\%}) vs 94{\%} (95{\%} CI, 89{\%}-97{\%}) (P<.001), respectively. For patients with and without ventricular couplets, 3- and 6-month OS was 94{\%} (95{\%} CI, 88{\%}-97{\%}) vs 94{\%} (95{\%} CI, 89{\%}-97{\%}) (P=.98) and 84{\%} (95{\%} CI, 75{\%}-89{\%}) vs 94{\%} (95{\%} CI, 89{\%}-97{\%}) (P=.01), respectively. Atrial fibrillation (hazard ratio, 2.5; 95{\%} CI, 1.2-5.0; P=.02) and NSVT (hazard ratio, 2.0; 95{\%} CI, 1.1-3.5; P=.02) were independent predictors for OS after accounting for age and Mayo stage. For patients undergoing routine testing before stem cell transplant, AF (P=.002) and NSVT (P=.02) were associated with inferior OS at 6 months but did not retain statistical significance after adjusting for Mayo stage (P=.10 and P=.54, respectively). Conclusion: Atrial fibrillation and NSVT on 24-hour Holter monitoring are associated with inferior short-term OS outcomes but do not impact peritransplant mortality.",
author = "Surbhi Sidana and Nidhi Tandon and Brady, {Peter A.} and Martha Grogan and Morie Gertz and Angela Dispenzieri and Lin, {Grace D} and Dingli, {David M} and Buadi, {Francis K.} and Martha Lacy and Prashant Kapoor and Wilson Gonsalves and Eli Muchtar and Rahma Warsame and Kumar, {Shaji K} and Taxiarchis Kourelis",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.mayocp.2018.08.039",
language = "English (US)",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",

}

TY - JOUR

T1 - Prognostic Significance of Holter Monitor Findings in Patients With Light Chain Amyloidosis

AU - Sidana, Surbhi

AU - Tandon, Nidhi

AU - Brady, Peter A.

AU - Grogan, Martha

AU - Gertz, Morie

AU - Dispenzieri, Angela

AU - Lin, Grace D

AU - Dingli, David M

AU - Buadi, Francis K.

AU - Lacy, Martha

AU - Kapoor, Prashant

AU - Gonsalves, Wilson

AU - Muchtar, Eli

AU - Warsame, Rahma

AU - Kumar, Shaji K

AU - Kourelis, Taxiarchis

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To evaluate the prognostic impact of Holter findings in patients with light chain amyloidosis. Patients and Methods: We evaluated 239 patients in whom light chain amyloidosis was diagnosed from January 1, 2010, through December 31, 2015, who underwent 24-hour Holter monitoring. Results: Holter testing was done before stem cell transplant evaluation in 183 of the 239 patients (76.6%) and at diagnosis in 50 (20.9%). Holter findings were nonsustained ventricular tachycardia (NSVT) in 60 patients (25.1%), ventricular couplets in 103 (43.1)%, accelerated idioventricular rhythm in 32 (13.4%), and atrial fibrillation (AF) in 18 (7.5%). Overall survival (OS) at 3 and 6 months after Holter monitoring in patients with AF vs without AF was 78% (95% CI, 54%-91%) vs 96% (95% CI, 92%-98%) (P=.002) and 61% (95% CI, 38%-80%) vs 92% (95% CI, 87%-95%), (P<.001), respectively. In patients with and without NSVT, 3- and 6-month OS after Holter testing was 90% (95% CI, 80%-94%) vs 96% (95% CI, 91%-98%) (P=.12) and 77% (95% CI, 64%-85%) vs 94% (95% CI, 89%-97%) (P<.001), respectively. For patients with and without ventricular couplets, 3- and 6-month OS was 94% (95% CI, 88%-97%) vs 94% (95% CI, 89%-97%) (P=.98) and 84% (95% CI, 75%-89%) vs 94% (95% CI, 89%-97%) (P=.01), respectively. Atrial fibrillation (hazard ratio, 2.5; 95% CI, 1.2-5.0; P=.02) and NSVT (hazard ratio, 2.0; 95% CI, 1.1-3.5; P=.02) were independent predictors for OS after accounting for age and Mayo stage. For patients undergoing routine testing before stem cell transplant, AF (P=.002) and NSVT (P=.02) were associated with inferior OS at 6 months but did not retain statistical significance after adjusting for Mayo stage (P=.10 and P=.54, respectively). Conclusion: Atrial fibrillation and NSVT on 24-hour Holter monitoring are associated with inferior short-term OS outcomes but do not impact peritransplant mortality.

AB - Objective: To evaluate the prognostic impact of Holter findings in patients with light chain amyloidosis. Patients and Methods: We evaluated 239 patients in whom light chain amyloidosis was diagnosed from January 1, 2010, through December 31, 2015, who underwent 24-hour Holter monitoring. Results: Holter testing was done before stem cell transplant evaluation in 183 of the 239 patients (76.6%) and at diagnosis in 50 (20.9%). Holter findings were nonsustained ventricular tachycardia (NSVT) in 60 patients (25.1%), ventricular couplets in 103 (43.1)%, accelerated idioventricular rhythm in 32 (13.4%), and atrial fibrillation (AF) in 18 (7.5%). Overall survival (OS) at 3 and 6 months after Holter monitoring in patients with AF vs without AF was 78% (95% CI, 54%-91%) vs 96% (95% CI, 92%-98%) (P=.002) and 61% (95% CI, 38%-80%) vs 92% (95% CI, 87%-95%), (P<.001), respectively. In patients with and without NSVT, 3- and 6-month OS after Holter testing was 90% (95% CI, 80%-94%) vs 96% (95% CI, 91%-98%) (P=.12) and 77% (95% CI, 64%-85%) vs 94% (95% CI, 89%-97%) (P<.001), respectively. For patients with and without ventricular couplets, 3- and 6-month OS was 94% (95% CI, 88%-97%) vs 94% (95% CI, 89%-97%) (P=.98) and 84% (95% CI, 75%-89%) vs 94% (95% CI, 89%-97%) (P=.01), respectively. Atrial fibrillation (hazard ratio, 2.5; 95% CI, 1.2-5.0; P=.02) and NSVT (hazard ratio, 2.0; 95% CI, 1.1-3.5; P=.02) were independent predictors for OS after accounting for age and Mayo stage. For patients undergoing routine testing before stem cell transplant, AF (P=.002) and NSVT (P=.02) were associated with inferior OS at 6 months but did not retain statistical significance after adjusting for Mayo stage (P=.10 and P=.54, respectively). Conclusion: Atrial fibrillation and NSVT on 24-hour Holter monitoring are associated with inferior short-term OS outcomes but do not impact peritransplant mortality.

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U2 - 10.1016/j.mayocp.2018.08.039

DO - 10.1016/j.mayocp.2018.08.039

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