{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T18:02:22Z","timestamp":1776448942449,"version":"3.51.2"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":92,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Heart Foundation of Northern Sweden","award":["20230511"],"award-info":[{"award-number":["20230511"]}]},{"DOI":"10.13039\/501100004359","name":"Swedish research Council","doi-asserted-by":"publisher","award":["2022-01254"],"award-info":[{"award-number":["2022-01254"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"publisher","award":["20230174"],"award-info":[{"award-number":["20230174"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Current diagnostic criteria for transthyretin amyloid (ATTR) cardiomyopathy (ATTR-CM) emphasize increased left ventricular (LV) wall thickness, potentially delaying recognition of early myocardial involvement. We evaluated whether combining ECG (S-wave amplitude in lead aVR, SaVR) with echocardiographic relative apical sparing (RELAPS) enhances the detection of ATTR-CM in patients with absent or mild LV hypertrophy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In this single-centre, retrospective observational study, 39 ATTR patients (72 [64\u201378] years; 45% female) with interventricular septal thickness \u226413\u2005mm were included. Diagnosis was confirmed by 99mTc\u2013DPD scintigraphy and\/or biopsy. Diagnostic performance of RELAPS\u2013SaVR was tested against two comparator groups: patients with mild LV hypertrophy and no evidence of amyloidosis, in addition to age-matched healthy controls with normal cardiovascular status. Peripheral neuropathy was the dominant clinical presentation (66%, n = 26), while overt cardiomyopathy presented in a minority (28%) of patients, consistent with early-stage disease. LVEF was preserved in 92%, and restrictive filling was absent. RELAPS \u22651 and SaVR &amp;lt;7\u202fmm was observed in 87% and 85%, respectively. Individually, RELAPS (AUC 0.83) and SaVR (AUC 0.85) distinguished ATTR-CM from LVH. The combined RELAPS\u2013SaVR model improved discrimination (AUC 0.90), with sensitivity 86%, specificity 94%, positive predictive value 76%, negative predictive value 97%, and overall accuracy 89%. Likelihood ratio testing confirmed its incremental value over RELAPS alone (LR\u202f=\u202f19.54; P\u202f&amp;lt;\u202f0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this single-centre retrospective study, integrating SaVR with RELAPS improved the detection of ATTR-CM in patients with absent or mild LV hypertrophy. These findings support a simple, non-invasive strategy for early detection that merits prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjimp\/qyag058","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T11:46:26Z","timestamp":1775130386000},"source":"Crossref","is-referenced-by-count":0,"title":["Integrating ECG and echocardiography to identify early-stage transthyretin amyloid cardiomyopathy"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0676-0604","authenticated-orcid":false,"given":"Ashwin","family":"Venkateshvaran","sequence":"first","affiliation":[{"name":"Department of Diagnostics and Intervention, Clinical Physiology, Ume\u00e5 University , Norrlands Universitetssjukhus, Byggnad 5A, M\u00e5lpunkt H62, Ume\u00e5 901 85 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