Diagnostic value of positron emission tomography using amyloid-binding radiotracers for cardiac amyloidosis: a systematic review and meta-analysis.
Amyloid PET shows high sensitivity and specificity for diagnosing cardiac amyloidosis, but further multicentre studies are needed to confirm its clinical role.
Where it sits
this study against the rest of the evuzamitide corpusSummary and findings
This study assessed the diagnostic accuracy of amyloid-binding positron emission tomography (PET) for detecting cardiac amyloidosis (CA) through a meta-analysis. The analysis included 20 studies with 577 patients, 407 of whom had CA. The primary findings indicated a summary sensitivity of 0.91 and specificity of 0.90.
Abstract
<h4>Aims</h4>Amyloid-binding positron emission tomography (PET) tracers have emerged as a promising non-invasive tool for the diagnosis of cardiac amyloidosis (CA). This study aimed to assess the diagnostic accuracy of amyloid PET for detecting CA through a meta-analysis of diagnostic test accuracy.<h4>Methods and results</h4>PubMed, Cochrane Library, Embase, and Web of Science were searched through 16 March 2026 for studies reporting the diagnostic performance of amyloid PET for CA. The primary analysis was a bivariate random-effects (Reitsma) model yielding summary sensitivity, specificity, the summary receiver operating characteristics curve with corresponding area under the curve (AUC), and positive and negative likelihood ratios. Subgroup analyses were performed by radiotracer and by amyloid subtype. Risk of bias was assessed using QUADAS-2 and publication bias by Deeks' funnel-plot asymmetry test. Twenty studies comprising 577 patients (407 with CA, 170 controls) met inclusion criteria, covering five radiotracers (<sup>11</sup>C-PiB, <sup>18</sup>F-florbetaben, <sup>18</sup>F-florbetapir, <sup>18</sup>F-flutemetamol, and <sup>124</sup>I-evuzamitide). In the primary bivariate model (<i>k</i> = 17), amyloid PET demonstrated a summary sensitivity of 0.91 (95% CI 0.83-0.96), specificity of 0.90 (95% CI 0.79-0.96), and AUC of 0.96, with low between-study heterogeneity (sensitivity <i>I</i> <sup>2</sup> = 13.4%; specificity <i>I</i> <sup>2</sup> = 0%). Sensitivity was high and consistent across <sup>11</sup>C-PiB, <sup>18</sup>F-florbetaben, <sup>18</sup>F-florbetapir, and <sup>124</sup>I-evuzamitide (0.96-1.00), with the exception of <sup>18</sup>F-flutemetamol, which showed lower and heterogeneous sensitivity (0.70).<h4>Conclusion</h4>Amyloid PET demonstrates high sensitivity and specificity for CA detection, even though the evidence base remains limited in terms of the number and scope of available studies. Prospective multicentre studies in consecutive patients with suspected CA are required to establish its clinical role and standardize acquisition protocols.