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Reference Ranges, Diagnostic and Prognostic Utility of Native T1 Mapping and Extracellular Volume for Cardiac Amyloidosis: A Meta‐Analysis
Author(s) -
Wang Tom Kai Ming,
Brizneda Maria Vega,
Kwon Deborah H.,
Popovic Zoran B.,
Flamm Scott D.,
Hanna Mazen,
Griffin Brian P.,
Xu Bo
Publication year - 2021
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.27459
Subject(s) - meta analysis , medicine , cardiac amyloidosis , amyloidosis , subgroup analysis , extracellular fluid , confidence interval , receiver operating characteristic , transthyretin , cardiology , nuclear medicine , extracellular , biology , microbiology and biotechnology
Background Cardiac MRI is central to the evaluation of cardiac amyloidosis (CA). Native T 1 mapping and extracellular volume (ECV) are novel MR techniques with evolving utility in cardiovascular diseases, including CA. Purpose To perform a meta‐analysis of the diagnostic and prognostic data of native T 1 mapping and ECV techniques for assessing CA. Study Type Systematic review and meta‐analysis. Population In all, 3520 patients including 1539 with CA from 22 studies retrieved following systematic search of Pubmed, Cochrane, and Embase. Field Strength/Sequence 1.5T or 3.0T/modified Look–Locker inversion recovery (MOLLI) or shortened MOLLI (shMOLLI) sequences. Assessment Meta‐analysis was performed for all CA and for light‐chain (AL) and transthyretin (ATTR) subtypes. Thresholds were calculated to classify native T 1 and ECV values as not suggestive, indeterminate, or suggestive of CA. Statistical Analysis Area under the receiver‐operating characteristic curves (AUCs) and hazards ratios (HRs) with 95% confidence intervals (95% CI) were pooled using random‐effects models and Open‐Meta(Analyst) software. Results Six studies were diagnostic, 16 studies reported T 1 and ECV values to determine reference range, and six were prognostic. Pooled AUCs (95% CI) for diagnosing CA were 0.92 (0.89–0.96) for native T 1 mapping and 0.96 (0.93–1.00) for ECV, with similarly high detection rates for AL‐ and ATTR‐CA. Based on the pooled values of native T 1 and ECV in CA and control subjects, the thresholds that suggested the absence, indeterminate, or presence of CA were identified as <994 msec, 994–1073 msec, and >1073 msec, respectively, for native T 1 at 1.5T. Pooled HRs (95% CI) for predicting all‐cause mortality were 1.15 (1.08–1.22) for native T 1 mapping as a continuous parameter, 1.19 (1.01–1.40) for ECV as a continuous parameter, and 4.93 (2.64–9.20) for ECV as a binary threshold. Data Conclusion Native T 1 mapping and ECV had high diagnostic performance and predicted all‐cause mortality in CA. Level of Evidence 1 Technical Efficacy Stage 2