Diagnostic Test Accuracy of Cardiac Biomarkers for Light Chain Amyloidosis: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Introduction: In patients with systemic light-chain amyloidosis, cardiac involvement is common. Cardiac involvement (presence and severity) is the most important predictor of mortality in patients with AL amyloidosis. Endomyocardial biopsy remains the gold standard, but it is a costly and invasive test. Consequently, cardiac biomarkers are used for screening for cardiac involvement and have significant prognostic value.In this systematic review, we aim to estimate the diagnostic test accuracy (DTA) of Nt-proBNP, BNP, and high sensitivity troponin for cardiac amyloidosis. Methods: As part of the American Society of Hematology guidelines on the diagnosis of Amyloidosis, we searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception till January 2024 for relevant studies. Two reviewers independently performed title and abstract screening and full-text article screening on LASER Al and extracted relevant data using piloted Excel sheets. The panel judged whether the reference test is acceptable or not. Acceptable reference test is EMB alone or a combination of extracardiac biopsy plus cardiac imaging (CMR or echocardiography) with or without positive cardiac biomarkers (troponin or BNP or NT-proBNP). For statistical analysis, we only included studies reporting on both the sensitivity and specificity of the cardiac biomarker. We used Stata 18.0 software for meta-analysis. We evaluated risk of bias using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of the evidence. We report diagnostic test accuracy as sensitivity (95% confidence interval) and specificity (95% confidence interval). Results: After screening 29,237 studies, a total of 10 studies addressed DTA of Nt-proBNP for cardiac amyloidosis. These studies used a wide variety of cutoffs for diagnosis of cardiac involvement, ranging from 150 to 5000 ng/L and a cutoff of 332 ng/L was the most studied and reported. The pooled estimates for sensitivity and specificity of Nt-proBNP using 332 as cutoffs are 0.99 ( 0.97, 1) and 0.53 (0.3, 0.75), respectively. The pooled estimates were based on 4 studies (n=645) with moderate certainty in the evidence. For BNP, DTA was assessed in 3 studies (n= 257). Each study used a different cutoff for BNP (73, 100, and 412 ng/L). The sensitivity and specificity of BNP in each study were comparable and not significantly affected by the cutoff variation. Pooled sensitivity and specificity across studies, were 0.87 (0.80, 0.92), and 0.79 (0.71, 0.85), respectively. The certainty in evidence for the DTA of BNP was low. Eight studies reported on DTA of high sensitivity troponin, with cutoffs ranging from 14 to 86 ng/L. Meta-analysis of studies reporting on cutoff 14 ng/L yielded sensitivity of 0.94 (0.87, 0.97) and specificity of 0.11 (0.08, 0.16) with moderate certainty evidence. Increasing the cutoff to 35 ng/l led to a decrease in sensitivity to 0.82 (0.66, 0.92) and an increase in specificity to 0.86 (0.74, 0.93) with low certainty evidence. Conclusion: Cardiac biomarkers are highly sensitive, valuable initial tests for increasing suspicion of cardiac involvement in patients with AL amyloidosis. However, they lack specificity and, on their own, are insufficient for a definitive diagnosis of cardiac involvement. These biomarkers may be used in conjunction with other diagnostic tests to accurately identify and assess the extent of cardiac involvement.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,025 | 0,075 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,021 | 0,038 |
| Bibliométrie | 0,008 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».