The apical sparing ratio demonstrated modest diagnostic performance for detecting cardiac amyloidosis, yielding a pooled sensitivity of 73% and specificity of 77% (AUC 0.81) at a threshold of 0.83.
Meta-Analysis (n=4,144)
Does the apical sparing ratio accurately detect cardiac amyloidosis in patients with left ventricular hypertrophy and severe aortic stenosis?
The apical sparing ratio demonstrates only modest diagnostic performance for differentiating cardiac amyloidosis from other hypertrophic phenotypes, limiting its utility as a standalone screening tool.
Estimación del efecto: AUC 0.81 (95% CI 0.69-0.89)
Abstract Purpose Cardiac amyloidosis (CA) is an underdiagnosed cause of heart failure with overlapping phenotypes, such as aortic stenosis (AS) and hypertrophic cardiomyopathy. The apical sparing ratio (ASR) derived from echocardiographic strain imaging has been widely adopted as a potential screening tool for CA, though performance across clinical contexts remains uncertain. Methods We performed a systematic review and meta‐analysis of studies evaluating the diagnostic accuracy of ASR for identifying CA among patients with left ventricular hypertrophy (LVH), including a prespecified subgroup of patients with severe AS, in September 2024. Random‐effects models incorporating multiple ASR thresholds were used to estimate pooled sensitivity, specificity, and area under the summary receiver operating characteristic curve (AUC). Results Among 3501 records screened, 22 studies ( n = 4144) met inclusion criteria for primary analysis. An optimal Youden ASR of threshold = 0.83 yielded pooled sensitivity (95% confidence interval) of 73% (66%, 79%) and specificity of 77% (67%, 84%), with an AUC of 0.81 (0.69, 0.89). In the severe AS subgroup (5 studies, n = 911), pooled sensitivity and specificity were 65% (47%, 80%) and 74% (58%, 85%), respectively, with an AUC of 0.79 (0.70, 0.92). Across analyses, high heterogeneity was observed. Sensitivity analyses, excluding high‐bias or low‐threshold studies, produced similar findings. Conclusion ASR demonstrates only modest diagnostic performance for differentiating CA from hypertrophic phenotypes, with limited sensitivity at conventional thresholds. These findings underscore the limitations of ASR as a standalone screening tool and highlight the need for alternative approaches to improve diagnostic accuracy.
Zheng et al. (Sat,) conducted a meta-analysis in Cardiac amyloidosis in left ventricular hypertrophy and severe aortic stenosis (n=4,144). Apical sparing ratio (ASR) was evaluated on Diagnostic accuracy (area under the summary receiver operating characteristic curve) (AUC 0.81, 95% CI 0.69-0.89). The apical sparing ratio demonstrated modest diagnostic performance for detecting cardiac amyloidosis, yielding a pooled sensitivity of 73% and specificity of 77% (AUC 0.81) at a threshold of 0.83.