{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:36:38Z","timestamp":1788543398663,"version":"build-2803163510"},"reference-count":19,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National High Level Hospital Clinical Research Funding","award":["2025-PUMCH-C-006"],"award-info":[{"award-number":["2025-PUMCH-C-006"]}]},{"name":"Xiong\u2019an New Area Science and Technology Innovation Special Project","award":["2023XAGG0069"],"award-info":[{"award-number":["2023XAGG0069"]}]},{"name":"Center for Rare Diseases Research, Chinese Academy of Medical Sciences, Beijing, China, the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences","award":["2021-I2M-1-003"],"award-info":[{"award-number":["2021-I2M-1-003"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Low QRS voltage relative to left ventricle (LV) thickness is one of the red flag characteristics in the diagnosis of cardiac amyloidosis, and it can be measured by specific indexes. Few studies have clearly defined the diagnostic threshold of voltage indexes for light chain amyloidosis cardiomyopathy (AL-CA) patients and other patients with LV hypertrophy. This case\u2013control study analyzed electrocardiograms and echocardiograms of patients with AL-CA, hypertrophic cardiomyopathy (HCM), and hypertension left ventricular hypertrophy (HTN-LVH) seen at a single university center from 2008 to 2022. Low QRS voltage and three different precordial voltage indexes were evaluated. Diagnostic thresholds for rule-in and rule-out were calculated for AL-CA against each control group. A single voltage\u2013mass ratio based on cross-sectional area (CSA) exhibited most accurate diagnostic accuracy, and the value of \u22641.72 aids the rule-in of AL-CA against other causes of left ventricular hypertrophy, providing a positive predictive value (PPV) of 86% versus HCM and 75% versus HTN-LVH.<\/jats:p>","DOI":"10.3390\/jcdd13010044","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T09:27:12Z","timestamp":1768296432000},"page":"44","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Novel Cut-Off Values of Precordial Voltage Indexes for Light Chain Amyloidosis Cardiomyopathy in a Chinese Population"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6105-5203","authenticated-orcid":false,"given":"Ruokai","family":"Pan","sequence":"first","affiliation":[{"name":"Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengsheng","family":"Zhuang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Xiamen Cardiovascular Hospital of Xiamen University, Xiamen 361006, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8384-2574","authenticated-orcid":false,"given":"Zeyuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuang","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of International Medical Service, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuyang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1093\/eurheartj\/ehab072","article-title":"Diagnosis and Treatment of Cardiac Amyloidosis: A Position Statement of the ESC Working Group on Myocardial and Pericardial Diseases","volume":"42","author":"Rapezzi","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1038\/s41569-020-0334-7","article-title":"Diagnostic Imaging of Cardiac Amyloidosis","volume":"17","author":"Baksi","year":"2020","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/echo.13782","article-title":"Relationship between QRS Measurements and Left Ventricular Morphology and Function in Asymptomatic Individuals","volume":"35","author":"Vancheri","year":"2018","journal-title":"Echocardiography"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1111\/jch.12678","article-title":"Does QRS Voltage Correction by Body Mass Index Improve the Accuracy of Electrocardiography in Detecting Left Ventricular Hypertrophy and Predicting Cardiovascular Events in a General Population?","volume":"18","author":"Cuspidi","year":"2016","journal-title":"J. Clin. Hypertens."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3517","DOI":"10.1093\/cvr\/cvac119","article-title":"Transthyretin Cardiac Amyloidosis","volume":"118","author":"Porcari","year":"2023","journal-title":"Cardiovasc. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.jaccao.2021.06.006","article-title":"ATTR Amyloidosis: Current and Emerging Management Strategies: JACC: CardioOncology State-of-the-Art Review","volume":"3","author":"Griffin","year":"2021","journal-title":"JACC CardioOncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.ejim.2023.09.026","article-title":"ECG\/Echo Indexes in the Diagnostic Approach to Amyloid Cardiomyopathy: A Head-to-Head Comparison from the AC-TIVE Study","volume":"122","author":"Pagura","year":"2024","journal-title":"Eur. J. Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/0002-9149(82)90270-3","article-title":"Amyloid Cardiomyopathy: Characterization by a Distinctive Voltage\/Mass Relation","volume":"49","author":"Carroll","year":"1982","journal-title":"Am. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E1586","DOI":"10.1016\/S0735-1097(12)61587-3","article-title":"A Simple Voltage\/Mass Index Improves Diagnosis of Cardiac Amyloidosis: An Electrocardiographic and Echocardiographic Study of 570 Patients with Left Ventricular Hypertrophy","volume":"59","author":"Quarta","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s10554-020-02059-1","article-title":"Indexed Left Ventricular Mass to QRS Voltage Ratio Is Associated with Heart Failure Hospitalizations in Patients with Cardiac Amyloidosis","volume":"37","author":"Slivnick","year":"2021","journal-title":"Int. J. 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Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.jjcc.2015.11.004","article-title":"Clinical Correlates and Prognostic Values of Pseudoinfarction in Cardiac Light-Chain Amyloidosis","volume":"68","author":"Zhao","year":"2016","journal-title":"J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1161\/CIRCULATIONAHA.108.843334","article-title":"Systemic Cardiac Amyloidoses: Disease Profiles and Clinical Courses of the 3 Main Types","volume":"120","author":"Rapezzi","year":"2009","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e12967","DOI":"10.1111\/anec.12967","article-title":"Utility and Pitfalls of the Electrocardiogram in the Evaluation of Cardiac Amyloidosis","volume":"27","author":"Ng","year":"2022","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/S1525-2167(03)00035-0","article-title":"M-mode echocardiography overestimates left ventricular mass in patients with normal left ventricular shape: A comparative study using three-dimensional echocardiography","volume":"4","author":"Hanrath","year":"2003","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/S0735-1097(85)80475-7","article-title":"Echocardiographic Findings in Systemic Amyloidosis: Spectrum of Cardiac Involvement and Relation to Survival","volume":"6","author":"Reeder","year":"1985","journal-title":"J. Am. Coll. 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