Abstract 4370144: Diagnostic Accuracy of Native T1 Mapping, Late Gadolinium Enhancement, and Extracellular Volume in Cardiac Amyloidosis: A Systematic Review and Meta-analysis

Background: Cardiac amyloidosis (CA) is a life-threatening infiltrative disorder that is frequently underdiagnosed due to its subtle and nonspecific clinical presentation. Accurate and early diagnosis is critical for optimizing patient outcomes, highlighting the need for advanced diagnostic tools. Aims: This meta-analysis aimed to assess the diagnostic accuracy of native T1 mapping, late gadolinium enhancement (LGE), and extracellular volume (ECV) quantification, as evaluated by cardiac magnetic resonance (CMR). Methods: A comprehensive systematic search of PubMed, EMBASE, and Cochrane CENTRAL databases was conducted through September 2024. Studies assessing the diagnostic performance of native T1 mapping, LGE, or ECV for detecting CA were included. Pooled estimates of sensitivity, specificity, and diagnostic odds ratios (DOR) were calculated, along with their respective 95% confidence intervals (CIs). Results: Thirty-four studies met the inclusion criteria. Bivariate analysis demonstrated ECV to have the highest area under the summary receiver operating characteristic curve (AUC = 0.95), followed by T1 mapping (AUC = 0.92) and LGE (AUC = 0.91). Pooled sensitivity and specificity values supported this trend. Conclusion: ECV quantification via CMR demonstrates the highest diagnostic accuracy for detecting CA, outperforming native T1 mapping and LGE. In conclusion, ECV is the most reliable diagnostic tool, highlighting its importance in the early and accurate detection of CA.