Cardiac magnetic resonance imaging and cardiac scintigraphy in the diagnosis of cardiac amyloidosis: A meta-analysis of 4866 patients

Cardiac amyloidosis (CA) impacts about 20 % of elderly heart failure patients, leading to myocardial dysfunction and life-threatening risks. However, it often remains undetected due to the significant risks associated with invasive biopsies. This highlights the critical need for safer and accurate non-invasive diagnostic techniques. To compare the diagnostic value of Cardiac Magnetic Resonance (CMR) imaging and Cardiac Scintigraphy Imaging in the diagnosis of CA. A comprehensive literature search across PubMed, Scopus, Web of Science, and Cochrane databases yielded studies that utilized CMR or cardiac scintigraphy for diagnosing CA. QUADAS-2 was employed for quality assessment. From 7117 records, 35 studies involving 4866 patients were analyzed. Cardiac scintigraphy demonstrated higher sensitivity and specificity across different radiotracers, with 99mTc-HMDP showing the highest specificity (1.00, 95 % CI: 0.93–1.00) and 99mTc-DPD the highest sensitivity (0.93, 95 % CI: 0.89–0.95). CMR imaging showed variable diagnostic accuracy with a sensitivity of 0.83 (95 % CI: 0.81–0.85) and a lower specificity of only 0.53 (95 % CI: 0.50–0.56). Cardiac scintigraphy, particularly with 99mTc-HMDP, offers superior diagnostic accuracy for CA compared to CMR imaging. Controlled, randomized, prospective studies directly comparing these non-invasive techniques are essential to validate these findings. • The study establishes that Cardiac Scintigraphy, especially with the radiotracer 99mTc-HMDP, provides more accurate diagnosis of Cardiac Amyloidosis compared to CMR. This method shows high specificity and sensitivity, making it particularly reliable for identifying patients with CA. • Different radiotracers used in Cardiac Scintigraphy exhibit varying levels of diagnostic accuracy. • Although CMR is a valuable tool for visualizing cardiac structure and function, it has limitations in specificity compared to Cardiac Scintigraphy, especially in distinguishing CA from other conditions like hypertrophic cardiomyopathy. • Recommendations for Clinical Practice: The manuscript suggests that the choice of diagnostic method should be tailored to individual patient scenarios.