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To explore sex differences in the history and cardiac phenotype of wild-type transthyretin cardiac amyloidosis (ATTRwt-CM) and determine sex- and age-related survival and prognostic factors. The objective of the present study was to determine the incidence of cardiac and extracardiac symptoms of ATTRwt-CM and evaluate the phenotypes and the prognosis as a function of sex and age. In a retrospective cohort study conducted at the French National Cardiac Amyloidosis Reference Centre, we compared women and men with regard to cardiac and non-cardiac phenotypes in age quartiles (Qs), using multiple regression analyses, supervised clustering, Cox models, and a Kaplan-Meier analysis. We included 1062 patients with ATTRwt-CM (180 women, 16%). The women had a higher median [interquartile range] left ventricular ejection fraction (LVEF; 52% [45–60] vs. 50 [43–58] in men) and a lower interventricular septum thickness. 12% of the women and 4.1% of the men had a septum thickness < 12 mm (P = 0.004). The women in Q1 (age at diagnosis ≤ 77 y) had lower LVEF and global longitudinal strain values and a higher prevalence of a septum < 12 mm (15.8%, vs 2.0% in men) than older women and men. The death rate was higher for women in Q1 than for women in Q2-4. Women had a greater risk of sudden death than men (13.8% vs. 4.6%, respectively; odds ratio [95% confidence interval]: 3.24 [1.56–6.64]; P = 0.001). Tafamidis treatment was associated with better survival in men (hazard ratio [95% confidence interval] = 0.61 [0.39–0.95]) but not in women. Younger women with ATTRwt-CM (≤ 77 y) had a thinner left ventricle wall but a higher death rate than older women and men. Decreasing the septum thickness cut-off would increase the frequency of ATTR-CM diagnosis in women. [ABSTRACT FROM AUTHOR]

Cardiac amyloidosis (CA) is a severe disease with poor prognosis and increasing incidence. Available scoring systems for prognostic stratification in light chain (AL) and transthyretin (ATTR) amyloidosis are based on limited biological parameters. Allowing process of a greater number and complexity of variables, machine learning (ML) could improve prognostic assessment. To investigate the feasibility and accuracy of supervised ML algorithms using clinical, biological and imaging features to predict all-cause mortality in CA patients. Data were collected from the French Referral Center for Cardiac Amyloidosis database (Hôpital Henri-Mondor, Créteil), including 1513 patients with wild type ATTR (n = 777), hereditary ATTR (n = 304) and AL (n = 432) CA between 2010 and 2023. Based on comprehensive clinical, biological and imaging features, we assessed accuracy of several supervised ML algorithms (Random Forest, Random Forest Ranger, XGBoost and LASSO) to predict all-cause mortality and compared with traditional logistic regression. Among 1513 CA included, 636 (42%) died during a median follow-up of 1.5 years (IQR: 0.5–3.1). ML score using XGBoost exhibited a higher area under the curve compared with logistic regression for prediction of all-cause mortality (AUC 0.76 vs 0.67, P < 0.001; Fig. 1). In ATTR cohort, ML score using Random Forest ranger evidenced better performance compared with logistic regression (AUC ML score 0.77 vs 0.72 with logistic regression, P = 0.008). However, in AL cohort, ML scores were not associated with an incremental prognostic value. A ML-model including clinical, biological and imaging parameters showed the best accuracy to predict all-cause mortality in CA patients compared with any traditional methods. [ABSTRACT FROM AUTHOR]

Introduction: The insertion of a peripheral venous line is of paramount importance in the stabilisation of critically ill patients. It is a preferred method of venous access over more invasive techniques due to its immediacy and fewer complications. Difficulties of catheterisation can result in delays to treatment, increased complication risks and pain, and a waste of valuable time and healthcare resources. Our hypothesis is that infrared vein illumination could improve the success rate of peripheral venous catheterisation in critically ill patients at risk of difficult catheterisation., Methods and Analysis: This is a prospective, multicentre, randomised, open-label controlled trial. It will be conducted in France and will involve critically ill patients at risk of difficult peripheral catheterisation. Patients will be randomly assigned to usual care or infrared vein illumination. The primary outcome is the rate of successful peripheral venous catheterisation at first puncture. Secondary outcomes include time to placement, overall rate of successful peripheral venous catheterisation, number of punctures, quality (calibre of the catheter), replacement rate, need for central line and local complications (dysfunction, diffusion, haematoma and lymphangitis)., Ethics and Dissemination: The study has been granted ethical approval (CPP Ile de France 1). Following the provision of informed consent, patients will be included in the study. The results will be submitted for publication in peer-reviewed journals., Trial Registration Number: NCT03932214., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)