Unlocking the potential of nailfold videocapillaroscopy in diagnosing and staging wild-type transthyretin amyloidosis: A preliminary approach.

Journal: Medicina clinica
Published Date: Jan 16, 2026

Abstract

BACKGROUND: Wild-type transthyretin amyloidosis (ATTRwt) is a serious condition. At early stages, symptoms resemble those of heart failure with preserved ejection fraction (HFpEF). Our aim was to perform software-supported nailfold videocapillaroscopy (NVC) analysis to identify hallmarks useful for diagnosis and build machine learning (ML)-based models to assess severity. METHODS: Thirty-two ATTRwt patients underwent NVC. Nineteen initiated TTR-stabilizing therapy and had a new NVC 12 months afterwards. Forty-one capillary-related variables were analyzed. Thirty NVCs were randomly chosen to train models to discriminate between poorer or less poor prognosis according to N-terminal pro-B-type natriuretic peptide (NT-proBNP) or Cheng score (cut-offs: 2000pg/mL and 4 points, respectively). The remaining 21 NVCs were used for validation purposes. A control population of 99 patients with heart failure with preserved ejection fraction (HFpEF) but without signs of amyloidosis was included. RESULTS: A profound disorganization in the nailfold capillary architecture was generally observed. The models achieved accuracies of 0.81 and 0.90, respectively, in predicting disease severity. An additional model designed to distinguish a profile suggestive of amyloidosis (vs. HFpEF controls) achieved an accuracy of 0.73. CONCLUSIONS: NVC-based ML models may contribute to early diagnosis and staging of ATTRwt.

Authors

  • Laura Pérez Abad
    Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
  • Miguel Ángel Aibar Arregui
    Internal Medicine, Lozano Blesa Clinical Hospital, Zaragoza, Spain; Member of the "GIIS-084" of the Instituto de Investigación Sanitaria de Aragón, Spain.
  • Jimena Aramburu Llorente
    Internal Medicine, Lozano Blesa Clinical Hospital, Zaragoza, Spain.
  • Juan Ramón Y Cajal Calvo
    Radiodiagnostic Area, Lozano Blesa Clinical Hospital, Zaragoza, Spain.
  • Alejandro Andrés Gracia
    Member of the "GIIS-084" of the Instituto de Investigación Sanitaria de Aragón, Spain; Multihospital Nuclear Medicine Unit of Aragón, Lozano Blesa Clinical Hospital, Zaragoza, Spain.
  • Pablo Revilla Martí
    Member of the "GIIS-084" of the Instituto de Investigación Sanitaria de Aragón, Spain; Cardiology Area Practitioner, Hospital Clínico Lozano Blesa, Zaragoza, Spain.
  • Saida Atienza Ayala
    Member of the "GIIS-084" of the Instituto de Investigación Sanitaria de Aragón, Spain; Neurology Area, Hospital Clínico Lozano Blesa, Zaragoza, Spain.
  • Carmen Lahuerta Pueyo
    Member of the "GIIS-084" of the Instituto de Investigación Sanitaria de Aragón, Spain; Clinical Biochemistry, Hospital Clínico Lozano Blesa, Zaragoza, Spain.
  • Amelia Campos Sáenz de Santamaría
    Internal Medicine, Lozano Blesa Clinical Hospital, Zaragoza, Spain.
  • Eduardo Ramos Ibáñez
    Ingeniero Informático, Universidad de Zaragoza, Zaragoza, Spain.
  • Borja Del Carmelo Gracia Tello
    Internal Medicine, Lozano Blesa Clinical Hospital, Zaragoza, Spain; Member of the "GIIS-009" of the Health Research Institute of Aragon, Spain; Spanish Systemic Autoimmune Diseases Group (GEAS), Spain. Electronic address: [email protected].

Keywords

No keywords available for this article.

External Resources

Popular Topics
Recent Journals