Diagnostic performance of imaging investigations in detecting and differentiating cardiac amyloidosis: a systematic review and meta‐analysis

Aims The study aims to systematically assess the diagnostic performance of cardiac magnetic resonance (CMR) and nuclear scintigraphy (index tests) for the diagnosis and differentiation of subtypes of cardiac amyloidosis. Methods and results MEDLINE and Embase electronic databases were searched for s...

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Published in:ESC Heart Failure Vol. 6; no. 5; pp. 1041 - 1051
Main Authors: Brownrigg, Jack, Lorenzini, Massimiliano, Lumley, Matthew, Elliott, Perry
Format: Journal Article
Language:English
Published: England John Wiley & Sons, Inc 01.10.2019
John Wiley and Sons Inc
Wiley
Subjects:
Amyloid Neuropathies, Familial - complications
Amyloid Neuropathies, Familial - diagnostic imaging
Amyloid Neuropathies, Familial - epidemiology
Amyloid Neuropathies, Familial - pathology
Amyloidosis - diagnostic imaging
Amyloidosis - pathology
Biopsy - standards
Cardiac amyloidosis
Cardiac magnetic resonance
Cardiomyopathy
Confidence intervals
Diagnosis, Differential
Heart Diseases - diagnostic imaging
Heart Diseases - pathology
Heart failure
Heart Failure - diagnostic imaging
Heart Failure - epidemiology
Heart Failure - etiology
Heart Failure - mortality
Humans
Immunoglobulin Light-chain Amyloidosis - complications
Immunoglobulin Light-chain Amyloidosis - diagnostic imaging
Immunoglobulin Light-chain Amyloidosis - epidemiology
Immunoglobulin Light-chain Amyloidosis - pathology
Light‐chain amyloidosis
Magnetic Resonance Imaging - methods
Medical prognosis
Meta-analysis
Mortality
Nuclear scintigraphy
Original
Original s
Patients
Prevalence
Proteins
Radionuclide Imaging - methods
Radionuclide Imaging - trends
Sensitivity and Specificity
Studies
Systematic review
Transthyretin amyloid cardiomyopathy
Heart failure
Cardiac amyloidosis
Light-chain amyloidosis
Nuclear scintigraphy
Transthyretin amyloid cardiomyopathy
Cardiac magnetic resonance
ISSN:2055-5822, 2055-5822
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Summary:Aims The study aims to systematically assess the diagnostic performance of cardiac magnetic resonance (CMR) and nuclear scintigraphy (index tests) for the diagnosis and differentiation of subtypes of cardiac amyloidosis. Methods and results MEDLINE and Embase electronic databases were searched for studies evaluating the diagnostic performance of CMR or nuclear scintigraphy in detecting cardiac amyloidosis and subsequently in differentiating transthyretin amyloidosis (ATTR) from immunoglobulin light‐chain (AL) amyloidosis. In this meta‐analysis, histopathological examination of tissue from endomyocardial biopsy (EMB) or extra‐cardiac organs were reference standards. Pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated, and a random effects meta‐analysis was used to estimate diagnostic odds ratios. Methodological quality was assessed using a validated instrument. Of the 2947 studies identified, 27 met the criteria for inclusion. Sensitivity and specificity of CMR in diagnosing cardiac amyloidosis was 85.7% and 92.0% against EMB reference and 78.9% and 93.9% with any organ histology reference. Corresponding sensitivity and specificity of nuclear scintigraphy was 88.4% and 87.2% against EMB reference and 82.0% and 98.8% with histology from any organ. CMR was unable to reliably differentiate ATTR from AL amyloidosis (sensitivity 28.1–99.0% and specificity 11.0–60.0%). Sensitivity and specificity of nuclear scintigraphy in the differentiation of ATTR from AL amyloidosis ranged from 90.9% to 91.5% and from 88.6% to 97.1%. Pooled negative likelihood ratio and positive likelihood ratio for scintigraphy in this setting were 0.1 and 8, with EMB reference standard. Study quality assessed by QUADAS‐2 was generally poor with evidence of bias. Conclusions Cardiac magnetic resonance is a useful test for diagnosing cardiac amyloidosis but is not reliable in further classifying the disease. Nuclear scintigraphy offers strong diagnostic performance in both the detection of cardiac amyloidosis and differentiating ATTR from AL amyloidosis. Our findings support the use of both imaging modalities in a non‐invasive diagnostic algorithm that also tests for the presence of monoclonal protein.
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ISSN:2055-5822
2055-5822
DOI:10.1002/ehf2.12511