Echocardiographic predictors of presence of cardiac amyloidosis in aortic stenosis

Abstract

Abstract Aims Aortic stenosis (AS) and cardiac amyloidosis (CA) frequently coexist but the diagnosis of CA in AS patients remains a diagnostic challenge. We aim to evaluate the echocardiographic parameters that may aid in the detection of the presence of CA in AS patients. Method and results We performed a systematic literature search of electronic databases for peer-reviewed articles from inception until 10 January 2022. Of the 1449 patients included, 160 patients had both AS–CA whereas the remaining 1289 patients had AS-only. The result of our meta-analyses showed that interventricular septal thickness [standardized mean difference (SMD): 0.74, 95% CI: 0.36–1.12, P = 0.0001), relative wall thickness (SMD: 0.74, 95% CI: 0.17–1.30, P < 0.0001), posterior wall thickness (SMD: 0.74, 95% CI 0.51 to 0.97, P = 0.0011), LV mass index (SMD: 1.62, 95% CI: 0.63–2.62, P = 0.0014), E/A ratio (SMD: 4.18, 95% CI: 1.91–6.46, P = 0.0003), and LA dimension (SMD: 0.73, 95% CI: 0.43–1.02, P < 0.0001)] were found to be significantly higher in patients with AS–CA as compared with AS-only patients. In contrast, myocardial contraction fraction (SMD: −2.88, 95% CI: −5.70 to −0.06, P = 0.045), average mitral annular S′ (SMD: −1.14, 95% CI: −1.86 to −0.43, P = 0.0017), tricuspid annular plane systolic excursion (SMD: −0.36, 95% CI: −0.62 to −0.09, P = 0.0081), and tricuspid annular S′ (SMD: −0.77, 95% CI: −1.13 to −0.42, P < 0.0001) were found to be significantly lower in AS–CA patients. Conclusion Parameters based on echocardiography showed great promise in detecting CA in patients with AS. Further studies should explore the optimal cut-offs for these echocardiographic variables for better diagnostic accuracy.