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Cardiac Magnetic Resonance Imaging and Cardiac Scintigraphy in the Diagnosis of Cardiac Amyloidosis: A Meta-Analysis of 4866 patients

https://doi.org/10.1007/s00392-025-02625-4

Mahmoud Balata (Bonn)1, A. M. Attia (Cairo)2, M. Elsmaan (London)3, M. Hassan (Giza)4, P. Rapeanu (Idar-Oberstein)5, M. Marinova (Bonn)6, S. Rashed (Chemnitz)7, U. Alkomi (Chemnitz)7, M. Rady (Chemnitz)7, K. Ibrahim (Chemnitz)7, M. U. Becher (Solingen)8, A. Youssef (Chemnitz)7

1Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; 2Faculty of Medicine, Cairo University Cairo, Ägypten; 3Guy's and St Thomas' NHS Foundation Trust London, Großbritannien; 4Theodor Bilharz Research Institute Giza, Ägypten; 5Klinikum Idar-Oberstein GmbH Medizinische Klinik II - Kardiologie Idar-Oberstein, Deutschland; 6Universitätsklinikum Bonn Radiologische Klinik Bonn, Deutschland; 7Klinikum Chemnitz gGmbH Innere Medizin I - Kardiologie Chemnitz, Deutschland; 8Städt. Klinikum Solingen gGmbH Klinik für Kardiologie und internistische Intensivmedizin Solingen, Deutschland

 

Introduction: 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.

Aim: To compare the diagnostic value of Cardiac Magnetic Resonance (CMR) imaging and Cardiac Scintigraphy Imaging in the diagnosis of CA.

Methods: 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.

Results: 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).  

Conclusion: 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.

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