The value of the electrocardiogram in the recognition of cardiac amyloidosis: a systematic meta-analysis.

OBJECTIVE

We conducted a systematic review and meta-analysis to assess the diagnostic value of the electrocardiogram (ECG) method in detecting cardiac amyloidosis (CA) to indicate its clinical application.

METHODS

We searched PubMed, Web of Science, OVID Medline, and Cochrane Library databases for clinical trials assessing the diagnostic performance of ECG in detecting CA. We employed the risk ratio and 95% confidence interval (CI) to explicit estimates. QUADAS-2 was applied to evaluate the bias risk and the clinical applicability of the included studies. Reviewer Manager (RevMan) 5.3 and Stata 16.0 were employed to complete all statistical analyses.

RESULTS

This meta-analysis included ten studies (N = 6353 patients). Overall, the findings of the study exposed that, for CA patients in whom the ECG method was used, the sensitivity and specificity were 0.49 and 0.91, respectively. The positive likelihood ratio (LR) and negative LR were 5.17 and 0.57, respectively. The diagnostic odds ratio (DOR) and diagnostic score of the ECG in detecting CA were 9.11 and 2.21. The area under the curve (AUC) was 0.83(95% CI = 0.79-0.86). The hierarchical summary receiver operating characteristic (HSROC) curve further confirmed the diagnostic accuracy of the ECG, demonstrating a high prediction and confidence interval for the pooled estimate. No significant publication bias was detected, as confirmed by funnel plot analysis. Sensitivity analysis confirmed that the pooled estimates for ECG remained stable after the exclusion of individual studies, underscoring the robustness of the findings. The combined DOR and diagnostic score were 9.11 and 2.21, respectively.

CONCLUSIONS

ECM has low sensitivity and high specificity in the diagnosis of CA. AUC > 0.5, indicating that ECM has accuracy and diagnostic value in the diagnosis of CA to some extent.