Background: Cardiac amyloidosis (CA) is frequently diagnosed in clinically stable patients, yet the risk of subsequent heart failure (HF) hospitalization remains difficult to predict using readily available tools. Early identification of high-risk outpatients is crucial to optimize follow-up and therapeutic strategies. Purpose: To develop a simple, non-invasive risk score to predict HF hospitalization in stable patients with cardiac amyloidosis using standard electrocardiographic and echocardiographic parameters. Methods: We prospectively enrolled 100 consecutive patients with confirmed cardiac amyloidosis from three tertiary centers. Baseline evaluation included clinical assessment, electrocardiography, and transthoracic echocardiography. The primary endpoint was HF hospitalization during follow-up; secondary endpoints were HF-related and all-cause mortality. Cox regression analysis was used to identify independent predictors of HF hospitalization and to derive a point-based risk (CAMY-HF) score. Results: During a median follow-up of 36 months, 55% of patients required HF hospitalization and 47% died. Low QRS voltage, interventricular septal thickness ≥14 mm, and left ventricular ejection fraction ≤40% independently predicted HF hospitalization and were incorporated into the CAMY-HF score (range, 0-4). HF hospitalization occurred in 0% of low-risk, 47.9% of intermediate-risk, and 80.6% of high-risk patients at 3 years. Higher CAMY-HF scores were also associated with increased HF-related and all-cause mortality. Conclusions: The CAMY-HF score is a simple, widely applicable tool for early risk stratification in clinically stable patients with cardiac amyloidosis. By relying on routine ECG and echocardiographic parameters, it may help identify outpatients at high risk of HF hospitalization and guide follow-up intensity and management strategies.

Pericardiocentesis is widely used for the management of malignant pericardial effusion and is generally considered a safe procedure; however, when complications occur, they may be sudden and fatal. We describe a 72-year-old woman with metastatic squamous cell lung carcinoma who presented with chest pain, progressive dyspnea, and palpitations. Electrocardiography revealed atrial fibrillation with low-voltage QRS complexes, and transthoracic echocardiography demonstrated a large circumferential pericardial effusion. As the patient developed worsening hypotension and clinical features of evolving cardiac tamponade, apical pericardiocentesis was performed, draining 350 mL of hemorrhagic, non-clotted fluid. Shortly after the procedure, imaging revealed malposition of the drainage catheter, initially within the right ventricle, with subsequent migration into the pulmonary artery. Urgent surgical exploration confirmed right ventricular perforation by the catheter in the presence of dense pericardial adhesions. Despite attempted catheter removal and creation of a pericardial window, the patient died intraoperatively from uncontrollable bleeding. This case illustrates that in patients with malignant pericardial disease, particularly those with prior pericardial interventions, pericardiocentesis may carry a high risk of catastrophic complications. Careful confirmation of catheter position and early consideration of surgical drainage are critical to improving patient safety in high-risk settings.

Cardiac amyloidosis is an infiltrative cardiomyopathy caused by extracellular deposition of misfolded proteins, leading to restrictive physiology and, in advanced stages, systolic dysfunction. Although transthyretin amyloidosis most commonly affects older adults, earlier presentations should prompt consideration of hereditary disease and genetic evaluation. We report a 47-year-old man admitted with advanced heart failure manifested by anasarca and progressive dyspnea. Electrocardiography showed low-voltage QRS complexes discordant with the degree of wall thickening. Transthoracic echocardiography revealed concentric left ventricular thickening with markedly reduced left ventricular ejection fraction (35%), and speckle-tracking demonstrated a reduced global longitudinal strain with relative apical sparing. Technetium-labeled bone scintigraphy demonstrated Perugini grade 2 myocardial uptake in the absence of monoclonal gammopathy, strongly supporting transthyretin cardiac amyloidosis (ATTR-CM). Tafamidis was initiated, and genetic testing was requested; however, results were not available at the time of manuscript submission. This case highlights that ATTR-CM should be considered in patients with unexplained heart failure and increased ventricular wall thickness even at a relatively young age, and that prompt diagnosis enables timely initiation of targeted therapy and supports genetic counseling and family screening when hereditary disease is suspected.

Pathogenic variants in the SCN5A gene and its subunits have been identified in individuals with Brugada Syndrome. One such SCN5A variant, c.689T>C(p.Ile230Thr), was previously reported as disease-causing only in homozygous individuals, with heterozygous carriers being unaffected. Presently, we discuss the case of an adolescent patient who presented for further evaluation of pre-syncopal episodes with ECG findings consistent with Brugada pattern who on further genetic evaluation was found to be a heterozygous carrier of the pathogenic SCN5A c.689T>C(p.Ile230Thr) variant. This unique case allows us to think differently about heterozygous carriers for this specific mutation, and while the risk for developing a life-threatening arrhythmia may be low, heterozygous carriers may benefit from clinical monitoring to reduce the potential for adverse cardiac outcomes. A 17-year-old male presented after a pre-syncopal episode whose ECG demonstrated sinus bradycardia and type 1 Brugada pattern. Genetic testing revealed this patient to be a heterozygous carrier of a pathogenic SCN5A variant (c.689T>C(p.Ile230Thr)) which was also found in his father and brother, neither of whom had symptoms but did have ECG changes. He was diagnosed with Brugada Syndrome and advised to avoid known triggers. This case highlights the potential risk of severe cardiac arrhythmias in heterozygous carriers of the SCN5A c.689T>C (p.Ile230Thr) variant, previously thought to be benign. The 17-year-old patient, along with his asymptomatic father and brother who also carried the variant, exhibited ECG changes consistent with Brugada pattern. This finding suggests that heterozygous carriers may require closer monitoring and early intervention to prevent future life-threatening cardiac events.

Soil co-contaminated with organic pollutants like pyrene and heavy metals present significant challenges for remediation. Existing technologies are generally ineffective at simultaneously removing both types of contaminants. This study proposes a novel approach-high-voltage pulsed blasting (HVPB) coupled with electrokinetic remediation (EKR)-for the treatment of soil co-contaminated with Cr, Cd and pyrene. Laboratory-scale experiments were conducted to evaluate the removal efficiency and underlying mechanisms of this method. HVPB generated strong oxidizing species, including ·OH and O3, which effectively degraded pyrene. Under conditions of 40 kV discharge voltage, 7 cm electrode spacing, and 10 % soil moisture content, pyrene degradation efficiency reached 76.1 % after 33 discharges. Moreover, HVPB fractured soil particles and enlarged their specific surface area, exposing contaminants trapped within soil lattices to pore water or particle surfaces. HVPB also facilitated the oxidation of immobile Cr(III) into the more mobile Cr(VI), thereby increasing the proportion of exchangeable heavy metals. After 7 h of EKR with prior HVPB treatment (2 V/cm voltage gradient, 0.5 mol/L acetic acid as the electrolyte, and EKG electrodes), the removal efficiencies of Cr(VI), Cr(III), and Cd reached 96.4 %, 87.0 %, and 70.2 %, respectively. Compared with conventional enhanced EKR, this approach markedly shortened treatment time, reduced energy consumption, and improved removal efficiency. The proposed HVPB-EKR method provides an efficient and low-carbon strategy for the rapid remediation of soil co-contaminated with PHAs and heavy metals.