Transcatheter Tricuspid Valve Edge-to-Edge Repair in Cardiac Wild-Type Transthyretin AmyloidosisSchwarting, Stolz, Novotny
et alJACC Case Rep (2025) 30 (6 Pt 2), 103414
Abstract: Cardiac transthyretin amyloidosis (ATTR-CM) is an infiltrative, restrictive cardiomyopathy leading to heart failure across all stages of the disease. While specific disease-modulating therapies evolve, interventional therapeutic approaches on atrioventricular valve dysfunction have not yet been investigated in this cardiomyopathy and remain subject to personalized strategy.We present 2 patients with wild-type ATTR-CM who underwent successful transcatheter tricuspid valve edge-to-edge repair (T-TEER) for severe tricuspid regurgitation (TR) 2-4 years after initial diagnosis. T-TEER was successful, and patients presented with a considerable improvement of their functional status.T-TEER represents an important therapeutic strategy for patients with TR and ATTR-CM, in whom treatment options for symptomatic improvement are scarce.T-TEER might be considered in patients with TR and restrictive cardiomyopathy, such as ATTR-CM in its advanced stages. Short-term outcomes demonstrate a considerable improvement of functional capacity on top of optimal medical therapy for ATTR-CM.Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
Explainable machine learning models for prediction of surgical site infection after posterior lumbar fusion surgery based on SHAPWang, Liu, Xie
et alWorld Neurosurg (2025)
Abstract: Retrospective study OBJECTIVES: This study aims to develop machine learning (ML) models combined with an explainable method for the prediction of surgical site infection (SSI) after posterior lumbar fusion surgery.In this retrospective, single-center study, a total of 1016 consecutive patients who underwent posterior lumbar fusion surgery were included. A comprehensive dataset was established, encompassing demographic variables, comorbidities, preoperative evaluation, details related to diagnosed lumbar disease, preoperative laboratory tests, surgical specifics, and postoperative factors. Utilizing this dataset, six ML models were developed to predict the occurrence of SSI. Performance evaluation of the models on the testing set involved several metrics, including the Receiver Operating Characteristic (ROC) curve, the Area Under the Curve (AUC), accuracy, recall, F1-score, and precision. The Shapley Additive Explanations (SHAP) method was employed to generate interpretable predictions, enabling a comprehensive assessment of SSI risk and providing individualized interpretations of the model results.Among the 1016 retrospective cases included in the study, 36 (3.54%) experienced SSI. Out of the six models examined, the XGBoost model demonstrated the highest discriminatory performance on the testing set, achieving the following metrics: precision (0.9000), recall (0.8182), accuracy (0.9902), F1 score (0.8571), and AUC (0.9447). By utilizing the SHAP method, several important predictors of SSI were identified, including the duration of indwelling jugular vein catheter, Bun levels, total protein levels, sustained fever, Cr levels, triglycerides levels, monocyte count, diabetes mellitus, drainage time, white blood cell count, cerebral infarction, estimated blood loss, prealbumin levels, prognostic nutritional index, low back pain, PF score, and osteoporosis.ML-based prediction tools can accurately assess the risk of SSI after posterior lumbar fusion surgery. Additionally, ML combined with SHAP could provide a clear interpretation of individualized risk prediction and give physicians an intuitive comprehension of the effects of the model's essential features.Copyright © 2025. Published by Elsevier Inc.
Amyloid deposits in prostate biopsy as an opportunity to diagnose early cardiac amyloidosisCespón-Fernández, Escalona-Canal, Sánchez-Ramos
et alJ Geriatr Cardiol (2025) 22 (1), 169-177
Abstract: The diagnostic delay of cardiac amyloidosis (CA) is known to be substantially long. A prolonged time from symptoms onset to diagnosis negatively impacts quality of life and life expectancy of the affected patients. We aim to describe the role of the incidental finding of amyloid deposits in prostatic tissue as an early marker of CA.A systematic cardiological evaluation, comprising ECG, echocardiogram and 99mTc-DPD scintigraphy, was offered to a cohort of 19 patients with incidental prostatic amyloidosis (PA) findings, propectively detected between 2014-2023, to assess cardiac involvement.The median age of the patients was 80.2 years (IQR: 74.9 -82.6 years). Histopathological study revealed amyloid deposits within the walls of small vessels (predominantly small arteries) in 18 patients and mainly in the stroma in the remaining case. All of them were immunohistochemically positive for transthyretin (ATTR) except one patient, with known myeloma, which was unconclusive fo ATTR. Clonal dyscrasia was excluded in the rest of the patients. Thirteen patients (68.4%) underwent all cardiological tests, 4 patients (21.1%) underwent only ECG and echocardiographic evaluation and two patients (10.5%) refused to undergo any cardiological study. Among 13 individuals undergoing the complete evaluation, six patients were eventually diagnosed with CA (46.15%). All of them were asymptomatic from a cardiovascular point of view at the time of the prostate biopsy.The finding of PA should prompt a complete cardiovascular examination, given the significant percentage of patients eventually diagnosed with early-stage CA. Multidisciplinary collaboration among different medical specialists must be encouraged, given the potential clinical impact of CA early diagnosis.© 2025 JGC All rights reserved; www.jgc301.com.
Advances in the screening, diagnosis, and treatment of transthyretin amyloid cardiomyopathy: New insights and future directionsGirard, Asif, Sperry
Trends Cardiovasc Med (2025)
Abstract: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive form of heart failure caused by myocardial tissue infiltration with fibrillar amyloid deposits. ATTR-CM has been traditionally underrecognized and regarded by clinicians as a challenging condition to manage, owing to limited availability of effective screening methods, diagnostic testing, and therapeutic options. More recently, multiple clinical trials have emerged evaluating the efficacy of novel pharmacologic therapies which target amyloid generation and pre-existing amyloid deposits. Results reveal robust treatment benefits in function and survival, offering clinicians and patients new therapeutics which alter the clinical trajectory of ATTR-CM. Importantly, the benefits of treatment with these therapies appear to be more pronounced when initiated at an early stage of disease. As a result, a renewed interest in the early detection of ATTR-CM has developed, with efforts currently underway to promote increased disease awareness and enhance diagnosis through standardized screening algorithms and advanced imaging techniques. This review will provide an in-depth description of the advancements in ATTR-CM screening, diagnosis, and treatment that are currently available for implementation in routine care. Furthermore, we highlight several investigational modalities on the horizon for ATTR-CM with a particular focus on their potential roles in future clinical practice.Copyright © 2025 Elsevier Inc. All rights reserved.
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