{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T16:43:18Z","timestamp":1786293798139,"version":"build-2736575974"},"reference-count":49,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Cardiac amyloidosis (CA) is an underdiagnosed cause of heart failure with overlapping phenotypes, such as aortic stenosis (AS) and hypertrophic cardiomyopathy. The apical sparing ratio (ASR) derived from echocardiographic strain imaging has been widely adopted as a potential screening tool for CA, though performance across clinical contexts remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review and meta\u2010analysis of studies evaluating the diagnostic accuracy of ASR for identifying CA among patients with left ventricular hypertrophy (LVH), including a prespecified subgroup of patients with severe AS, in September 2024. Random\u2010effects models incorporating multiple ASR thresholds were used to estimate pooled sensitivity, specificity, and area under the summary receiver operating characteristic curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 3501 records screened, 22 studies (\n                      <jats:italic>n<\/jats:italic>\n                      = 4144) met inclusion criteria for primary analysis. An optimal Youden ASR of threshold = 0.83 yielded pooled sensitivity (95% confidence interval) of 73% (66%, 79%) and specificity of 77% (67%, 84%), with an AUC of 0.81 (0.69, 0.89). In the severe AS subgroup (5 studies,\n                      <jats:italic>n<\/jats:italic>\n                      = 911), pooled sensitivity and specificity were 65% (47%, 80%) and 74% (58%, 85%), respectively, with an AUC of 0.79 (0.70, 0.92). Across analyses, high heterogeneity was observed. Sensitivity analyses, excluding high\u2010bias or low\u2010threshold studies, produced similar findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ASR demonstrates only modest diagnostic performance for differentiating CA from hypertrophic phenotypes, with limited sensitivity at conventional thresholds. These findings underscore the limitations of ASR as a standalone screening tool and highlight the need for alternative approaches to improve diagnostic accuracy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/echo.70474","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T11:18:36Z","timestamp":1777115916000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Accuracy of the Apical Sparing Ratio for Detecting Cardiac Amyloidosis in Left Ventricular Hypertrophy and Severe Aortic Stenosis: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"43","author":[{"given":"Eric","family":"Zheng","sequence":"first","affiliation":[{"name":"University of Massachusetts Chan Medical School  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Garza","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine The University of Chicago Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Vetter","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine The University of Chicago Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan E Xin","family":"Tan","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Cotella","sequence":"additional","affiliation":[{"name":"Cardi\u00f3logo en Altos de Salta Swiss Medical Group  Tucuman Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Randazzo","sequence":"additional","affiliation":[{"name":"Division of Cardiology Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Slivnick","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine The University of Chicago Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv338"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2021.3070"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.15112"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1805689"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.13681"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/13506129.2018.1498782"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl\u20102012\u2010302353"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2019.08.001"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.13738"},{"issue":"3","key":"e_1_2_10_11_1","first-page":"283","article-title":"Prevalence and Prognostic Impact of Apical Sparing Contractility Pattern in Patients With Aortic Stenosis Referred for Transcatheter Aortic Valve Implantation","volume":"11","author":"Ferreira V. V.","year":"2021","journal-title":"American Journal of Cardiovascular Disease"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeae021"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/circimaging.122.014645"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.21037\/qims\u201023\u20101292"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2020190069"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2019.07.015"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.4178\/epih.e2022083"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010016\u20100196\u20101"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2532"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2021200142"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2022.09.011"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2022.12.021"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ\u201014\u20101328"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554\u2010022\u201002692\u2010y"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11144120"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00380\u2010022\u201002048\u20105"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/cpf.12715"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.3109\/13506129.2015.1037831"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.1756"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ\u201020\u20101064"},{"issue":"4","key":"e_1_2_10_31_1","first-page":"203","article-title":"Measures of Diagnostic Accuracy: Basic Definitions","volume":"19","author":"\u0160imundi\u0107 A. M.","year":"2009","journal-title":"EJIFCC"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2025.111816"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ\u201024\u20100472"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2019.10.011"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2022.1781"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf362"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2020.03.012"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jead032"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2025.08.017"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554\u2010023\u201002806\u20100"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.116.005588"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaa043"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/echo.14833"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12947\u2010021\u201000258\u2010x"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.6515\/ACS.202205_38(3).20211209A"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554\u2010024\u201003158\u2010z"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00259\u2010023\u201006374\u20102"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeae263"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872\u2010024\u201004415\u20108"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2023.05.002"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70474","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.70474","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.70474","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T16:26:34Z","timestamp":1786292794000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.70474"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,25]]},"references-count":49,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/echo.70474"],"URL":"https:\/\/doi.org\/10.1111\/echo.70474","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,25]]},"assertion":[{"value":"2025-10-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70474"}}