In established wild-type transthyretin amyloid cardiomyopathy, LVH-voltage discordance was associated with worse baseline GLS, a less favorable longitudinal GLS trajectory, and HF-related outcomes, and 'may provide a simple marker for within-disease phenotyping.'
LVH-voltage discordance was present in 41.8% of newly diagnosed wtATTR-CM patients.
Absolute global longitudinal strain (GLS) was significantly lower in patients with LVH-voltage discordance compared to those without.
Impaired GLS (defined as <16%) was substantially more prevalent among patients with LVH-voltage discordance.
The continuous QRS amplitude-to-wall-thickness index correlated positively with absolute GLS.
LVH-voltage discordance was associated with significantly higher risk of cardiovascular death or first heart failure hospitalization over a median 16-month follow-up.
Among patients with serial imaging, discordance was associated with a greater annual decline in GLS over time.
This research suggests that in patients with wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) — a condition where an abnormal protein builds up in the heart muscle — there is a clinically meaningful mismatch between how thick the heart walls appear on ultrasound and how much electrical signal the heart produces on an ECG. Normally, a thicker heart wall generates a stronger electrical signal, but in this disease, the thickening is caused by protein deposits rather than true muscle growth, so the electrical signal may stay low. The study found that about 4 in 10 newly diagnosed patients had this 'discordance,' and those patients had significantly worse heart pump function (measured by global longitudinal strain) and were roughly 3.5 to 4 times more likely to be hospitalized for heart failure or die from cardiovascular causes over roughly 16 months of follow-up. The study also found that patients with this discordance showed a faster decline in heart function over time when followed with repeated ultrasound exams. A simple numerical index combining the ECG voltage and wall thickness measurements correlated meaningfully with heart function, suggesting it captures something real about disease severity. These findings indicate that this straightforward ECG-to-ultrasound comparison could help doctors identify which wtATTR-CM patients are at higher risk within this already serious diagnosis. This research is notable because it offers a potentially simple, low-cost way to stratify patients with an established diagnosis of wtATTR-CM — a disease that is increasingly recognized and now has approved treatments. However, the study was conducted at a single center with a relatively short follow-up, and the authors themselves call for external validation before these findings are broadly applied. The results suggest that combining ECG and echocardiography data in this way may help clinicians better understand disease severity and guide monitoring or treatment intensity.
Bahadır N, Osman Şeker O, Dereli S. (2026). LVH-Voltage Discordance and Myocardial Dysfunction in Wild-Type Transthyretin Cardiomyopathy: A Prospective Cohort Study.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70625