Diagnostic accuracy of cardiovascular magnetic resonance for patients with suspected cardiac amyloidosis: a systematic review and meta-analysis

Abstract

BackgroundThis study is a systematic review and meta-analysis of the diagnostic value of cardiovascular magnetic resonance (CMR) in cardiac amyloidosis (CA).MethodsA wide variety of electronic databases were searched for studies of CMR that reported the diagnostic accuracy in patients with suspected CA. Research manuscripts were subjected to further systematic review and meta-analysis. Methodological evaluation was performed under the guidance of the Quality Assessment of Diagnostic Accuracy Studies −2 (QUADAS–2). Heterogeneity was assessed, and a random-effects model was used to assess the diagnostic effects of CMR on pooled sensitivity, pooled specificity, and summary receiver operating characteristics (SROC).ResultsSeven studies that reported the performance of CMR for CA were included in the present systematic review, among which five studies (257 patients) that evaluated the diagnostic accuracy of late gadolinium enhancement (LGE) CMR were analyzed in the present meta-analysis. Heterogeneity was observed only in specificity. A summary sensitivity and specificity of 85 % (95 % CI: 77–91 %) and 92 % (95 % CI: 83–97 %) indicated a high diagnostic accuracy of LGE for CA. The AUC of SROC curve was 0.9530, suggesting that LGE is an effective way of diagnosing patients with possible cardiac involvement in amyloidosis.ConclusionsLGE–CMR seems to have a relatively high diagnostic accuracy for amyloidosis patients with possible cardiac involvement. Combined CMR techniques may provide important information for the selection of suitable therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0311-6) contains supplementary material, which is available to authorized users.

Quantification of 11C-PIB kinetics in cardiac amyloidosis

“…Heart involvement was diagnosed by myocardial biopsy (N=2) or echocardiography (N=6), according to the criteria published by Gertz et al, 8 whereas in one patient heart involvement was diagnosed by cardiac magnetic resonance imaging. [9][10][11] Written informed consent was obtained from all subjects and the study was performed with permission from the Regional Board of Medical Ethics in Uppsala and in accordance with the declaration of Helsinki.…”

“…The 11 C-labelled PET tracer Pittsburg compound B ( 11 C-PIB) was developed for visualization and quantification of amyloid deposits in the brain in Alzheimers disease. 3 This tracer is also able to visualize amyloid deposits in the heart in patients with both immunoglobulin light-chain (AL) and transthyretin-related (ATTR) amyloidosis 4,5 and a recent study has shown similar results for 18 F-florbetapir PET.…”

Echocardiography and cardiovascular MRI entwined within the imaging domain; uniting the two. A compendium for the echocardiographer

“…In cardiac amyloidosis, gadolinium contrast is avidly taken up into the interstitium from the amyloid protein giving a diffuse, circumferential enhancement of the left ventricle that is a pathognomonic pattern for cardiac amyloidosis (Figure ). A recent meta‐analysis showed that CMR for amyloidosis has a sensitivity and specificity of 85% and 92%, respectively . In addition, the circumferential extent of enhancement has been shown to discriminate between ATTR and AL amyloidosis suggesting that in the future, endomyocardial biopsies may no longer be needed for cardiac amyloidosis .…”

“…A recent meta-analysis showed that CMR for amyloidosis has a sensitivity and specificity of 85% and 92%, respectively. 9 In addition, the circumferential extent of enhancement has been shown to discriminate between ATTR and AL amyloidosis suggesting that in the future, endomyocardial biopsies may no longer be needed for cardiac amyloidosis. 10 As patients with amyloid commonly have renal failure and cannot be given gadolinium, T1…”

Transthyretin Cardiac Amyloidosis in Older Adults: Optimizing Cardiac Imaging to the Corresponding Diagnostic and Management Goal

“…Patients with CA demonstrate characteristic patterns of LGE including global subendocardial [32–36] and transmural enhancement [37, 38]. A recent meta-analysis of five studies (257 patients) assessing the diagnostic accuracy of LGE assessment by CMR demonstrated a sensitivity of 85% and specificity of 92% for CA [39]. …”