Table 4 Assessments for monitoring progression in cardiac dysfunction
Technique | Indicator of progression | Frequency of assessment | Sensitivity to progressiona |
|---|---|---|---|
Clinical examination | Progression indicated by: | 3–6 months | High |
 New signs and symptoms of CHF | |||
 Unplanned cardiac hospitalization | |||
Uncontrolled heart failure that would request to increase the diuretic dosage or the need of using intravenous diuretics | |||
6MWT | If no disabling neuropathy, progression indicated by a decrease of 20–30 m | 6 months | High |
Check heart rate response during 6MWT for chronotropic incompetence | |||
12-lead ECG | New bundle branch block or AV block of any degree | 6Â months | High/medium |
New microvoltage or pseudo myocardial infarction pattern; new arrhythmias (atrial and ventricular, atrial fibrillation, bradycardia, AV block) | |||
Holter ECG | New arrhythmias, burden of atrial fibrillation, need for pacing, VT/VF. If new syncope: repeat Holter for sinus dysfunction, atrial fibrillation, atrial or ventricular arrhythmias, and consider EPS | 1Â year | High |
EPS | Asymptomatic conduction abnormalities (left or right bundle branch block and/or prolonged PR interval) | When clinically indicated based on clinical or ECG changes | Medium |
New conduction abnormalities or indication for pacemaker or defibrillator implantation according to existing guidelines or clinical situation | |||
Pacemaker memory | Check for bouts of asymptomatic atrial fibrillation requiring anticoagulation | 6Â months | Medium |
Check for worsening of AV block degree if device has a function for preservation of physiologic AV conduction information | |||
Echocardiographyb | Myocardial thickness and regional LV strain measurement mandatory. Doppler filling parameters, EF. Strain measurements | 1Â year | Medium |
Progression indicated by: | |||
 Increased myocardial thickness (wall thickness 2 mm increase with other symptoms/findings) | |||
 Decreased basal strain | |||
 Worsening diastolic dysfunction | |||
 Decrease in EF | |||
Same operator should be used for consecutive assessments | |||
Cardiac magnetic resonance imagingb | Changes noted in the report; T1, ECV, wall thickness, EF | 1Â year when clinically indicated by ambiguous echo changes | High |
Scintigraphy with bone tracersb | PYP or DPD cardiac uptake using qualitative Perugini grading 1–3, quantification using H/L ratio. Repeat scan only if initial scan was negative, and if > 3 years, and echo shows significant increase in wall thickness | 3 years | High |
Do not repeat once scan is positive | |||
Persistent change in the patients’ Grogan or Gillmore stage | 6 months | Medium | |
Cardiac biomarkers: NT-proBNP, troponin I, troponin T | Progression indicated by trend increase | 3–6 months | High |