Key result
Concurrent cardiac amyloidosis in aortic stenosis was associated with significantly higher interventricular septal thickness compared to aortic stenosis alone (SMD 0.74; 95% CI 0.36-1.12; P=0.0001).
Why the study?
Aortic stenosis and cardiac amyloidosis frequently coexist, but diagnosing cardiac amyloidosis in patients with aortic stenosis remains a clinical challenge.
Which echocardiographic parameters predict the presence of cardiac amyloidosis in patients with aortic stenosis?
Meta-Analysis (n=1,449)
Which echocardiographic parameters predict the presence of cardiac amyloidosis in patients with aortic stenosis?
Specific echocardiographic parameters, including increased septal thickness and LV mass index, and decreased myocardial contraction fraction, can help identify coexisting cardiac amyloidosis in patients with aortic stenosis.
Increased septal thickness may aid amyloidosis detection in aortic stenosis; leaves open need for prospective validation before changing practice.
AIMS: Aortic stenosis (AS) and cardiac amyloidosis (CA) frequently coexist but the diagnosis of CA in AS patients remains a diagnostic challenge. We aim to evaluate the echocardiographic parameters that may aid in the detection of the presence of CA in AS patients. METHOD AND RESULTS: We performed a systematic literature search of electronic databases for peer-reviewed articles from inception until 10 January 2022. Of the 1449 patients included, 160 patients had both AS-CA whereas the remaining 1289 patients had AS-only. The result of our meta-analyses showed that interventricular septal thickness [standardized mean difference (SMD): 0.74, 95% CI: 0.36-1.12, P = 0.0001), relative wall thickness (SMD: 0.74, 95% CI: 0.17-1.30, P < 0.0001), posterior wall thickness (SMD: 0.74, 95% CI 0.51 to 0.97, P = 0.0011), LV mass index (SMD: 1.62, 95% CI: 0.63-2.62, P = 0.0014), E/A ratio (SMD: 4.18, 95% CI: 1.91-6.46, P = 0.0003), and LA dimension (SMD: 0.73, 95% CI: 0.43-1.02, P < 0.0001)] were found to be significantly higher in patients with AS-CA as compared with AS-only patients. In contrast, myocardial contraction fraction (SMD: -2.88, 95% CI: -5.70 to -0.06, P = 0.045), average mitral annular S' (SMD: -1.14, 95% CI: -1.86 to -0.43, P = 0.0017), tricuspid annular plane systolic excursion (SMD: -0.36, 95% CI: -0.62 to -0.09, P = 0.0081), and tricuspid annular S' (SMD: -0.77, 95% CI: -1.13 to -0.42, P < 0.0001) were found to be significantly lower in AS-CA patients. CONCLUSION: Parameters based on echocardiography showed great promise in detecting CA in patients with AS. Further studies should explore the optimal cut-offs for these echocardiographic variables for better diagnostic accuracy.
No takes yet. Share an insight, caveat, or question.
Jaiswal et al. (2022) conducted a meta-analysis in Aortic stenosis and cardiac amyloidosis (n=1,449). Concurrent cardiac amyloidosis (AS-CA) vs. Aortic stenosis alone (AS-only) was evaluated on Interventricular septal thickness (SMD 0.74, 95% CI 0.36-1.12, p=0.0001). Concurrent cardiac amyloidosis in aortic stenosis was associated with significantly higher interventricular septal thickness compared to aortic stenosis alone (SMD 0.74; 95% CI 0.36-1.12; P=0.0001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:
More on EchocardiographyMore from European Heart Journal - Cardiovascular Imaging