Diagnosis
Computed tomography (CT)-derived myocardial extracellular volume fraction (ECV) is a noninvasive method to quantify myocardial fibrosis 2.
Pooled CT-derived ECV values are significantly elevated in cardiac amyloidosis (48.9%; 95% CI: 44.5%-53.3%) compared to controls (28.5%; 95% CI: 27.3%-29.7%) and aortic stenosis (31.9%; 95% CI: 30.2%-33.8%) 2.
CT-derived ECV demonstrates high diagnostic accuracy for cardiac amyloidosis, with a sensitivity of 92.8% (95% CI: 86.7%-96.2%), specificity of 84.8% (95% CI: 68.6%-93.4%), and an area under the summary receiver-operating characteristic curve of 0.94 (95% CI: 0.88-1.00) 2.Management
Dietary sodium restriction in patients with chronic heart failure (CHF) was associated with a higher risk of the composite endpoint of all-cause mortality and heart failure-related hospitalizations (OR 4.12 [95% CI 1.23-13.82]) 1.Key Recommendations
CT-derived myocardial extracellular volume fraction (ECV) can be utilized as a noninvasive diagnostic tool for cardiac amyloidosis due to its high sensitivity and specificity 2. (Evidence: Strong)
Routine dietary sodium restriction in patients with chronic heart failure may not improve clinical outcomes and could be associated with an increased risk of mortality and hospitalizations 1. (Evidence: Strong)References
1 Urban S, Fułek M, Błaziak M, Fułek K, Iwanek G, Jura M et al.. Role of dietary sodium restriction in chronic heart failure: systematic review and meta-analysis. Clinical research in cardiology : official journal of the German Cardiac Society 2024. link
2 Kato S, Misumi Y, Horita N, Yamamoto K, Utsunomiya D. Clinical Utility of Computed Tomography-Derived Myocardial Extracellular Volume Fraction: A Systematic Review and Meta-Analysis. JACC. Cardiovascular imaging 2024. link