Prediction of Cardiac Transthyretin Amyloidosis: Electrocardiographic Parameters and the Ratio of Posterior Wall Thickness to the Minimum QRS Complex Voltage in Limb Leads

Gawor-Prokopczyk, Monika; Lipowska, Marta; Sioma, Agnieszka; Chrustowicz, Anton; Henzel, Jan; Grzybowski, Jacek; Szczygieł, Justyna; Wójcik, Anna; Konka, Marek; Kowalik, Ewa; Teresińska, Anna; Mazurkiewicz, Łukasz

doi:10.3390/biomedicines13102493

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Prediction of Cardiac Transthyretin Amyloidosis: Electrocardiographic Parameters and the Ratio of Posterior Wall Thickness to the Minimum QRS Complex Voltage in Limb Leads

by

Monika Gawor-Prokopczyk

^1,*,

Marta Lipowska

^2,†,

Agnieszka Sioma

¹,

Anton Chrustowicz

¹,

Jan Henzel

³

,

Jacek Grzybowski

¹,

Justyna Szczygieł

¹,

Anna Wójcik

⁴,

Marek Konka

⁴,

Ewa Kowalik

⁴,

Anna Teresińska

⁵

and

Łukasz Mazurkiewicz

¹

Department of Cardiomyopathy, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland

²

Department of Neurology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland

³

Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland

⁴

Department of Congenital Heart Diseases, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland

⁵

Department of Nuclear Medicine, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland

^*

Author to whom correspondence should be addressed.

^†

European Reference Network on Rare Neuromuscular Disease (ERN EURO-NMD); Website: https://ern-euro-nmd.eu/.

Biomedicines 2025, 13(10), 2493; https://doi.org/10.3390/biomedicines13102493 (registering DOI)

Submission received: 2 September 2025 / Revised: 1 October 2025 / Accepted: 4 October 2025 / Published: 13 October 2025

(This article belongs to the Special Issue Advancements in Cardiac Imaging: Diagnostics, Prognostics, and Therapeutics)

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Abstract

Background/Objectives: Several predictive models have been proposed to estimate the probability of cardiac transthyretin amyloidosis (ATTR-CA). The aim of our study was to evaluate the usefulness of electrocardiographic parameters, as well as parameters consisting of a combination of myocardial thickness and QRS voltage, as potential predictors of ATTR-CA. Methods: In 2018–2025, 285 consecutive patients with suspected cardiac amyloidosis were evaluated, including blood tests, standard 12-lead electrocardiography, transthoracic echocardiography, and [^99mTc]Tc-DPD scintigraphy. Results: The ratio of posterior wall thickness to minimum QRS voltage in limb leads (PWT/minQRS ratio) as well as several ECG-derived parameters were independent predictors of ATTR-CA. In a comparison of ROC curves, PWT/minQRS ratio exceeded both the minimum and maximum voltage of QRS complexes in limb leads, demonstrated similar predictive value to TCAS and T-amylo scores, and had similar or superior predictive characteristics to posterior wall thickness. A cut-off of >3.3 for PWT/minQRS ratio was as accurate as the published cut-offs for TCAS score ≥6, T-amylo score ≥7, and posterior wall thickness ≥14 mm. In the subgroup of patients with myocardial thickness of at least 15 mm, PWT/minQRS ratio >3.3 was superior to posterior wall thickness ≥14 mm and T-amylo score ≥7 and had similar predictive value for ATTR-CA as TCAS score ≥6. Conclusions: In a cohort of undifferentiated patients referred for [99mTc]Tc-DPD scintigraphy due to suspected cardiac amyloidosis, PWT/minQRS ratio showed strong predictive value for ATTR-CA, which was even more pronounced in the subgroup of patients with increased myocardial thickness.

Keywords: cardiac imaging; echocardiography; electrocardiography; cardiac amyloidosis; score; T-amylo; TCAS; transthyretin amyloidosis

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MDPI and ACS Style

Gawor-Prokopczyk, M.; Lipowska, M.; Sioma, A.; Chrustowicz, A.; Henzel, J.; Grzybowski, J.; Szczygieł, J.; Wójcik, A.; Konka, M.; Kowalik, E.; et al. Prediction of Cardiac Transthyretin Amyloidosis: Electrocardiographic Parameters and the Ratio of Posterior Wall Thickness to the Minimum QRS Complex Voltage in Limb Leads. Biomedicines 2025, 13, 2493. https://doi.org/10.3390/biomedicines13102493

AMA Style

Gawor-Prokopczyk M, Lipowska M, Sioma A, Chrustowicz A, Henzel J, Grzybowski J, Szczygieł J, Wójcik A, Konka M, Kowalik E, et al. Prediction of Cardiac Transthyretin Amyloidosis: Electrocardiographic Parameters and the Ratio of Posterior Wall Thickness to the Minimum QRS Complex Voltage in Limb Leads. Biomedicines. 2025; 13(10):2493. https://doi.org/10.3390/biomedicines13102493

Chicago/Turabian Style

Gawor-Prokopczyk, Monika, Marta Lipowska, Agnieszka Sioma, Anton Chrustowicz, Jan Henzel, Jacek Grzybowski, Justyna Szczygieł, Anna Wójcik, Marek Konka, Ewa Kowalik, and et al. 2025. "Prediction of Cardiac Transthyretin Amyloidosis: Electrocardiographic Parameters and the Ratio of Posterior Wall Thickness to the Minimum QRS Complex Voltage in Limb Leads" Biomedicines 13, no. 10: 2493. https://doi.org/10.3390/biomedicines13102493

APA Style

Gawor-Prokopczyk, M., Lipowska, M., Sioma, A., Chrustowicz, A., Henzel, J., Grzybowski, J., Szczygieł, J., Wójcik, A., Konka, M., Kowalik, E., Teresińska, A., & Mazurkiewicz, Ł. (2025). Prediction of Cardiac Transthyretin Amyloidosis: Electrocardiographic Parameters and the Ratio of Posterior Wall Thickness to the Minimum QRS Complex Voltage in Limb Leads. Biomedicines, 13(10), 2493. https://doi.org/10.3390/biomedicines13102493

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Prediction of Cardiac Transthyretin Amyloidosis: Electrocardiographic Parameters and the Ratio of Posterior Wall Thickness to the Minimum QRS Complex Voltage in Limb Leads

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