Artificial Intelligence-Based Echocardiographic Assessment for Monitoring Disease Progression in Transthyretin Cardiac Amyloidosis

作者：Lucia Venneri, Alberto Aimo, Aldostefano Porcari, İrem Sezer, Adam Ioannou, Awais Sheikh, Josephine Mansell, Yousuf Razvi, Surabhi Bhaskar Iyer, Ana Martinez–Naharro, Francesco Bandera, See Lim, Matthew Frost, Justin A. Ezekowitz, Carolyn S.P. Lam, William E. Moody, Carol Whelan, Helen J. Lachmann, Ashutosh Wechelakar, Michele Emdin, Philip N. Hawkins, Scott D. Solomon, Julian D. Gillmore, Marianna Fontana · 发表于：European Journal of Heart Failure · 年份：2025 · DOI：10.1002/ejhf.70073 · 被引用次数：5 · 研究领域：Amyloidosis: Diagnosis, Treatment, Outcomes、Parathyroid Disorders and Treatments、Cardiovascular Function and Risk Factors

AIMS: In transthyretin amyloid cardiomyopathy (ATTR-CM), reduced stroke volume (SV) portends a poor prognosis. Artificial intelligence (AI) enables rapid, standardized assessment of left ventricular outflow tract velocity-time integral (LVOT-VTI), which is a reliable surrogate for SV. We investigated longitudinal changes in AI-derived LVOT-VTI as outcome predictors in ATTR-CM. METHODS AND RESULTS: Consecutive patients with ATTR-CM underwent baseline and 12 ± 1 month transthoracic echocardiography between 2007 and 2021. Scans were processed by an AI platform for fully automated measurements including LVOT-VTI. Changes in echocardiographic variables were related to all-cause mortality in a landmark analysis using multivariable Cox models adjusting for clinical covariates (age, sex, TTR genotype, atrial fibrillation status, New York Heart Association class and National Amyloidosis Centre stage). Time-dependent receiver-operating characteristic analysis identified the optimal threshold of LVOT-VTI change. A total of 752 patients (74 ± 9 years; 88% men; 66% wild-type) were followed for a median of 3.3 years (interquartile range 2.1-5.0 years), during which 334 (44.4%) died. Among changes in echocardiographic parameters over 12 months, only LVOT-VTI change remained independently prognostic (adjusted hazard ratio [HR] per 1% decrease 0.994, p = 0.025). A ≥5% decrease (n = 377 patients, 50%) independently predicted all-cause mortality (adjusted HR 1.41, 95% confidence interval 1.13-1...