{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T08:48:28Z","timestamp":1791881308416,"version":"4.3.4"},"reference-count":47,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"unspecified","delay-in-days":100,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["PNRR-MR1-2022-12376614; CUP: C63C22001610006"],"award-info":[{"award-number":["PNRR-MR1-2022-12376614; CUP: C63C22001610006"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021856","name":"Ministero dell\u2019Universit\u00e0 e della Ricerca","doi-asserted-by":"publisher","award":["E53D23020580001"],"award-info":[{"award-number":["E53D23020580001"]}],"id":[{"id":"10.13039\/501100021856","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100021856","name":"Ministero dell\u2019Universit\u00e0 e della Ricerca","doi-asserted-by":"publisher","award":["PRIN 2022 PNRR P2022P97PJ -Machine"],"award-info":[{"award-number":["PRIN 2022 PNRR P2022P97PJ -Machine"]}],"id":[{"id":"10.13039\/501100021856","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,9,22]]},"published-print":{"date-parts":[[2026,7]]},"DOI":"10.1136\/openhrt-2026-004243","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:25:14Z","timestamp":1791606314000},"page":"e004243","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal artificial intelligence to predict cardiomyopathy development in hereditary transthyretin amyloidosis"],"prefix":"10.1136","volume":"13","author":[{"given":"Leopoldo","family":"Ordine","sequence":"first","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Pacella","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Tozza","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia","family":"Canciello","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elio","family":"Masciari","sequence":"additional","affiliation":[{"name":"Department of Electrical Engineering and Information Technologies, University of Naples Federico II, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella","family":"De Luca","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5025-6993","authenticated-orcid":false,"given":"Raffaella","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia","family":"Foti","sequence":"additional","affiliation":[{"name":"De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Martano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Vito Fazzi Hospital, Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Marazia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Vito Fazzi Hospital, Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Di Bella","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Mazzeo","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiore","family":"Manganelli","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9819-0401","authenticated-orcid":false,"given":"Maria Angela","family":"Losi","sequence":"additional","affiliation":[{"name":"Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"2026101301050762000_13.2.e004243.1","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1007\/s10072-020-04889-2","article-title":"Hereditary transthyretin amyloidosis overview","volume":"43","author":"Manganelli","year":"2022","journal-title":"Neurol Sci"},{"key":"2026101301050762000_13.2.e004243.2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-019-0210-4"},{"key":"2026101301050762000_13.2.e004243.3","doi-asserted-by":"crossref","first-page":"5746","DOI":"10.1007\/s00415-024-12509-8","article-title":"Hereditary transthyretin amyloidosis: a myriad of factors that influence phenotypic variability","volume":"271","author":"Carvalho","year":"2024","journal-title":"J Neurol"},{"key":"2026101301050762000_13.2.e004243.4","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.119.006075","article-title":"Expert Consensus Recommendations for the Suspicion and Diagnosis of Transthyretin Cardiac Amyloidosis","volume":"12","author":"Maurer","year":"2019","journal-title":"Circ Heart Fail"},{"key":"2026101301050762000_13.2.e004243.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13023-023-02962-5","article-title":"A 15-year consolidated overview of data in over 6000 patients from the Transthyretin Amyloidosis Outcomes Survey (THAOS)","volume":"18","author":"Gentile","year":"2023","journal-title":"Orphanet J Rare Dis"},{"key":"2026101301050762000_13.2.e004243.6","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1093\/eurjpc\/zwae011","article-title":"Characterization and natural history of different phenotypes in hereditary transthyretin amyloidosis: 40-year experience at a single Italian referral centre","volume":"31","author":"Caponetti","year":"2024","journal-title":"Eur J Prev Cardiol"},{"key":"2026101301050762000_13.2.e004243.7","doi-asserted-by":"crossref","DOI":"10.3390\/diagnostics15172143","article-title":"Parallel Neurological and Cardiac Progression in Hereditary Transthyretin Amyloidosis: An Integrated Clinical and Imaging Study","volume":"15","author":"Canciello","year":"2025","journal-title":"Diagnostics (Basel)"},{"key":"2026101301050762000_13.2.e004243.8","doi-asserted-by":"publisher","DOI":"10.1080\/13506129.2022.2070470"},{"key":"2026101301050762000_13.2.e004243.9","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs123"},{"key":"2026101301050762000_13.2.e004243.10","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.121.318187"},{"key":"2026101301050762000_13.2.e004243.11","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.118.038169"},{"key":"2026101301050762000_13.2.e004243.12","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2011-301299"},{"key":"2026101301050762000_13.2.e004243.13","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx589"},{"key":"2026101301050762000_13.2.e004243.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.04.015"},{"key":"2026101301050762000_13.2.e004243.15","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy404"},{"key":"2026101301050762000_13.2.e004243.16","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.tcm.2024.08.002","article-title":"Artificial intelligence-driven electrocardiography: Innovations in hypertrophic cardiomyopathy management","volume":"35","author":"Ordine","year":"2025","journal-title":"Trends Cardiovasc Med"},{"key":"2026101301050762000_13.2.e004243.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.12.054"},{"key":"2026101301050762000_13.2.e004243.18","doi-asserted-by":"crossref","DOI":"10.1038\/s41467-021-22877-8","article-title":"Artificial intelligence-enabled fully automated detection of cardiac amyloidosis using electrocardiograms and echocardiograms","volume":"12","author":"Goto","year":"2021","journal-title":"Nat Commun"},{"key":"2026101301050762000_13.2.e004243.19","doi-asserted-by":"crossref","DOI":"10.3390\/ijms24065680","article-title":"Machine Learning Approaches in Diagnosis, Prognosis and Treatment Selection of Cardiac Amyloidosis","volume":"24","author":"Allegra","year":"2023","journal-title":"Int J Mol Sci"},{"key":"2026101301050762000_13.2.e004243.20","doi-asserted-by":"crossref","first-page":"3392","DOI":"10.1002\/ejhf.70073","article-title":"Artificial Intelligence-Based Echocardiographic Assessment for Monitoring Disease Progression in Transthyretin Cardiac Amyloidosis","volume":"27","author":"Venneri","year":"2025","journal-title":"Eur J Heart Fail"},{"key":"2026101301050762000_13.2.e004243.21","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.126.019610","article-title":"Multimodal Artificial Intelligence for Cardiac Amyloidosis Diagnosis: Integrating Echocardiography With Clinical and Laboratory Data for Improved Detection","volume":"19","author":"Slivnick","year":"2026","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026101301050762000_13.2.e004243.22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1716153"},{"key":"2026101301050762000_13.2.e004243.23","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1716793"},{"key":"2026101301050762000_13.2.e004243.24","doi-asserted-by":"publisher","DOI":"10.1080\/13506129.2022.2091985"},{"key":"2026101301050762000_13.2.e004243.25","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.18688"},{"key":"2026101301050762000_13.2.e004243.26","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2409134"},{"key":"2026101301050762000_13.2.e004243.27","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad194"},{"key":"2026101301050762000_13.2.e004243.28","doi-asserted-by":"crossref","first-page":"S39","DOI":"10.3233\/JND-150091","article-title":"Transthyretin-Related Familial Amyloid Polyneuropathy (TTR-FAP): A Single-Center Experience in Sicily, an Italian Endemic Area","volume":"2","author":"Mazzeo","year":"2015","journal-title":"J Neuromuscul Dis"},{"key":"2026101301050762000_13.2.e004243.29","doi-asserted-by":"crossref","DOI":"10.3390\/biomedicines10112877","article-title":"Quantitative Sensory Testing in Late-Onset ATTRv Presymptomatic Subjects: A Single Center Experience","volume":"10","author":"Tozza","year":"2022","journal-title":"Biomedicines"},{"key":"2026101301050762000_13.2.e004243.30","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1080\/13506129.2021.1931099","article-title":"A simple core dataset and disease severity score for hereditary transthyretin (ATTRv) amyloidosis","volume":"28","author":"Damy","year":"2021","journal-title":"Amyloid"},{"key":"2026101301050762000_13.2.e004243.31","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCGEN.120.003259","article-title":"Prediction of Genotype Positivity in Patients With Hypertrophic Cardiomyopathy Using Machine Learning","volume":"14","author":"Liang","year":"2021","journal-title":"Circ Genom Precis Med"},{"key":"2026101301050762000_13.2.e004243.32","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1038\/s44161-025-00679-1","article-title":"Multimodal AI to forecast arrhythmic death in hypertrophic cardiomyopathy","volume":"4","author":"Lai","year":"2025","journal-title":"Nat Cardiovasc Res"},{"key":"2026101301050762000_13.2.e004243.33","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/s41569-020-00503-2","article-title":"Artificial intelligence-enhanced electrocardiography in cardiovascular disease management","volume":"18","author":"Siontis","year":"2021","journal-title":"Nat Rev Cardiol"},{"key":"2026101301050762000_13.2.e004243.34","doi-asserted-by":"crossref","DOI":"10.1038\/s41467-022-29153-3","article-title":"Automated multilabel diagnosis on electrocardiographic images and signals","volume":"13","author":"Sangha","year":"2022","journal-title":"Nat Commun"},{"key":"2026101301050762000_13.2.e004243.35","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.124.036533","article-title":"Value of Artificial Intelligence for Enhancing Suspicion of Cardiac Amyloidosis Using Electrocardiography and Echocardiography: A Narrative Review","volume":"14","author":"Grogan","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"2026101301050762000_13.2.e004243.36","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1093\/eurheartj\/ehaf667","article-title":"Transthyretin amyloid cardiomyopathy: from cause to novel treatments","volume":"47","author":"Fontana","year":"2026","journal-title":"Eur Heart J"},{"key":"2026101301050762000_13.2.e004243.37","doi-asserted-by":"publisher","DOI":"10.3109\/13506129.2013.825240"},{"key":"2026101301050762000_13.2.e004243.38","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0173086","article-title":"Impact of genotype and phenotype on cardiac biomarkers in patients with transthyretin amyloidosis - Report from the Transthyretin Amyloidosis Outcome Survey (THAOS)","volume":"12","author":"Kristen","year":"2017","journal-title":"PLoS One"},{"key":"2026101301050762000_13.2.e004243.39","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182661eb1"},{"key":"2026101301050762000_13.2.e004243.40","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/13506129.2018.1556156","article-title":"Early diagnosis of ATTR amyloidosis through targeted follow-up of identified carriers of TTR gene mutations","volume":"26","author":"Concei\u00e7\u00e3o","year":"2019","journal-title":"Amyloid"},{"key":"2026101301050762000_13.2.e004243.41","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1002\/ejhf.3339","article-title":"Evaluation of the 2021 ESC recommendations for family screening in hereditary transthyretin cardiac amyloidosis","volume":"26","author":"Muller","year":"2024","journal-title":"Eur J Heart Fail"},{"key":"2026101301050762000_13.2.e004243.42","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-014-9462-7"},{"key":"2026101301050762000_13.2.e004243.43","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2198"},{"key":"2026101301050762000_13.2.e004243.44","article-title":"Vutrisiran Treatment and Changes in Cardiac Parameters and Amyloid Burden Assessed by Cardiovascular MRI","volume":"PubMed Central PMCID","author":"Razvi","year":"2026","journal-title":"JAMA Cardiol"},{"key":"2026101301050762000_13.2.e004243.45","doi-asserted-by":"crossref","DOI":"10.1093\/ehjopen\/oeaf147","article-title":"Relative efficacy of tafamidis, acoramidis, patisiran and vutrisiran in patients with transthyretin cardiac amyloidosis: a network meta-analysis","volume":"5","author":"Aimo","year":"2025","journal-title":"Eur Heart J Open"},{"key":"2026101301050762000_13.2.e004243.46","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1016\/j.hroo.2025.06.022","article-title":"Enhancing explainability in clinical deep-learning models: Latent-space variable decoding is superior to gradient-weighted class activation mapping","volume":"6","author":"Carrick","year":"2025","journal-title":"Heart Rhythm O2"},{"key":"2026101301050762000_13.2.e004243.47","doi-asserted-by":"crossref","first-page":"3651","DOI":"10.1093\/eurheartj\/ehaf450","article-title":"Artificial intelligence-enabled electrocardiography and echocardiography to track preclinical progression of transthyretin amyloid cardiomyopathy","volume":"46","author":"Oikonomou","year":"2025","journal-title":"Eur Heart J"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2026-004243","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T08:05:19Z","timestamp":1791878719000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2026-004243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":47,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,10,9]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/openhrt-2026-004243"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2026-004243","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}