{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:19:38Z","timestamp":1789755578045,"version":"4.0.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure, yet detection remains challenging due to its echocardiographic similarities with age- and hypertension-related cardiac remodelling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We retrospectively included 260 patients (76.5 \u00b1 12.9 years old, 59.6% male) referred for suspected ATTR-CM. A supervised machine-learning diagnosis algorithm differentiating patients with (n = 111) and without (n = 149) ATTR-CM based on echocardiographic data, and subsequently validated in an external multicentre cohort of 454 patients (76.3 \u00b1 12.6 years old, 69.1% male). Patients with ATTR-CM had a lower systolic function [left ventricular ejection fraction 47 \u00b1 11 vs. 54 \u00b1 12%, P &amp;lt; 0.00; global longitudinal strain (GLS) 11.0 \u00b1 3.7 vs. 14.1 \u00b1 4.5%, P &amp;lt; 0.001] and more significant relative apical longitudinal sparing (RALS) (1.5 \u00b1 1.2 vs. 0.9 \u00b1 0.4, P &amp;lt; 0.001) compared with controls. Machine learning identified right ventricular free wall thickness (RVFWT), RALS, GLS, and LV mass index as key variables for detecting ATTR-CM [AUC 0.90 (0.86\u20130.94); P &amp;lt; 0.001]. These variables enhanced diagnostic accuracy compared with the increased wall thickness guideline score [increase in C-index of 0.17 (0.11\u20130.23), P &amp;lt; 0.001]. Diagnostic performance was confirmed in the validation multicentre cohort [AUC of 0.83 (0.80\u20130.87), P &amp;lt; 0.001]<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The simple GRAAL algorithm (GLS, RVFWT, Apical spAring, LV Mass) enhances detection accuracy for ATTR-CM and improves patient selection for bone scintigraphy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjdh\/ztag022","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T12:21:13Z","timestamp":1774268473000},"source":"Crossref","is-referenced-by-count":1,"title":["Machine-learning approach on echocardiography to improve the detection of transthyretin amyloid cardiomyopathy: GRAAL algorithm"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9932-2274","authenticated-orcid":false,"given":"Antoine","family":"Fraix","sequence":"first","affiliation":[{"name":"Cardiology Department, Institut Lorrain du C\u0153ur et des Vaisseaux, CHRU de Nancy , Site Brabois, 54500 Vandoeuvre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Huttin","sequence":"additional","affiliation":[{"name":"Cardiology Department, Institut Lorrain du C\u0153ur et des Vaisseaux, CHRU de Nancy , Site Brabois, 54500 Vandoeuvre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4520-4810","authenticated-orcid":false,"given":"Claire","family":"Lacomblez","sequence":"additional","affiliation":[{"name":"INSERM, Centre D\u2019Investigations Cliniques-1433, and INSERM U1116, Universit\u00e9 de Lorraine, CHRU de Nancy, 54500 Vandoeuvre ,","place":["France"]},{"name":"F-CRIN INI-CRCT, (Cardiovascular and Renal Clinical Trialists) , Universit\u00e9 de Lorraine, Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Pace","sequence":"additional","affiliation":[{"name":"Cardiology Department, Institut Lorrain du C\u0153ur et des Vaisseaux, CHRU de Nancy , Site Brabois, 54500 Vandoeuvre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre-Yves","family":"Marie","sequence":"additional","affiliation":[{"name":"Cardiology Department, Institut Lorrain du C\u0153ur et des Vaisseaux, CHRU de Nancy , Site Brabois, 54500 Vandoeuvre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Mandry","sequence":"additional","affiliation":[{"name":"Cardiology Department, Institut Lorrain du C\u0153ur et des Vaisseaux, CHRU de Nancy , Site Brabois, 54500 Vandoeuvre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marine","family":"Claudin","sequence":"additional","affiliation":[{"name":"Cardiology Department, Institut Lorrain du C\u0153ur et des Vaisseaux, CHRU de Nancy , Site Brabois, 54500 Vandoeuvre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Sadoul","sequence":"additional","affiliation":[{"name":"Cardiology Department, Institut Lorrain du C\u0153ur et des Vaisseaux, CHRU de Nancy , Site Brabois, 54500 Vandoeuvre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Filippetti","sequence":"additional","affiliation":[{"name":"Cardiology Department, Institut Lorrain du C\u0153ur et des Vaisseaux, CHRU de Nancy , Site Brabois, 54500 Vandoeuvre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2677-3389","authenticated-orcid":false,"given":"Erwan","family":"Donal","sequence":"additional","affiliation":[{"name":"Cardiology Department, Universit\u00e9 de Rennes-1 , 35000 Rennes ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8141-6582","authenticated-orcid":false,"given":"Olivier","family":"Lairez","sequence":"additional","affiliation":[{"name":"Cardiology Department, Rangueil University Hospital , 31400 Toulouse ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuelle","family":"Lointier","sequence":"additional","affiliation":[{"name":"Cardiology Department, Rangueil University Hospital , 31400 Toulouse ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amira","family":"Zaroui","sequence":"additional","affiliation":[{"name":"French Referral Centre for Cardiac Amyloidosis, Amyloidosis Mondor Network, GRC Amyloid Research Institute, CHU Henri Mondor , Creteil 94000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thibaud","family":"Damy","sequence":"additional","affiliation":[{"name":"French Referral Centre for Cardiac Amyloidosis, Amyloidosis Mondor Network, GRC Amyloid Research Institute, CHU Henri Mondor , Creteil 94000 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Selton-Suty","sequence":"additional","affiliation":[{"name":"Cardiology Department, Institut Lorrain du C\u0153ur et des Vaisseaux, CHRU de Nancy , Site Brabois, 54500 Vandoeuvre ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3278-2057","authenticated-orcid":false,"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"Cardiology Department, Institut Lorrain du C\u0153ur et des Vaisseaux, CHRU de Nancy , Site Brabois, 54500 Vandoeuvre ,","place":["France"]},{"name":"INSERM, Centre D\u2019Investigations Cliniques-1433, and INSERM U1116, Universit\u00e9 de Lorraine, CHRU de Nancy, 54500 Vandoeuvre ,","place":["France"]},{"name":"F-CRIN INI-CRCT, (Cardiovascular and Renal Clinical Trialists) , Universit\u00e9 de Lorraine, Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"2026032422060462500_ztag022-B1","doi-asserted-by":"crossref","first-page":"2342","DOI":"10.1002\/ejhf.2532","article-title":"Redefining the epidemiology of cardiac amyloidosis. 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