Diagnostic Accuracy of the Apical Sparing Ratio for Detecting Cardiac Amyloidosis in Left Ventricular Hypertrophy and Severe Aortic Stenosis: A Systematic Review and Meta‐Analysis
Fuente:
Wiley Open Access
Gespeichert in:
| Hauptverfasser: | , , , , , , |
|---|---|
| Format: | Artículo Open Access |
| Veröffentlicht: |
Wiley
2026
|
| Schlagworte: | |
| Online-Zugang: | |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| _version_ | 1867019586546696192 |
|---|---|
| author | Eric Zheng Alejandro Garza Sara Vetter Bryan E Xin Tan Juan Cotella Michael Randazzo Jeremy Slivnick |
| author_facet | Eric Zheng Alejandro Garza Sara Vetter Bryan E Xin Tan Juan Cotella Michael Randazzo Jeremy Slivnick Eric Zheng Alejandro Garza Sara Vetter Bryan E Xin Tan Juan Cotella Michael Randazzo Jeremy Slivnick |
| collection | Wiley Open Access |
| contents | Diagnostic Accuracy of the Apical Sparing Ratio for Detecting Cardiac Amyloidosis in Left Ventricular Hypertrophy and Severe Aortic Stenosis: A Systematic Review and Meta‐Analysis Eric Zheng Alejandro Garza Sara Vetter Bryan E Xin Tan Juan Cotella Michael Randazzo Jeremy Slivnick Echocardiography 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. 10.1111/echo.70474 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/echo.70474 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_echo_70474 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2026 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Diagnostic Accuracy of the Apical Sparing Ratio for Detecting Cardiac Amyloidosis in Left Ventricular Hypertrophy and Severe Aortic Stenosis: A Systematic Review and Meta‐Analysis Eric Zheng Alejandro Garza Sara Vetter Bryan E Xin Tan Juan Cotella Michael Randazzo Jeremy Slivnick Echocardiography Diagnostic Accuracy of the Apical Sparing Ratio for Detecting Cardiac Amyloidosis in Left Ventricular Hypertrophy and Severe Aortic Stenosis: A Systematic Review and Meta‐Analysis Eric Zheng Alejandro Garza Sara Vetter Bryan E Xin Tan Juan Cotella Michael Randazzo Jeremy Slivnick Echocardiography 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. 10.1111/echo.70474 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Diagnostic Accuracy of the Apical Sparing Ratio for Detecting Cardiac Amyloidosis in Left Ventricular Hypertrophy and Severe Aortic Stenosis: A Systematic Review and Meta‐Analysis |
| topic | Echocardiography |
| url | https://onlinelibrary.wiley.com/doi/10.1111/echo.70474 |