Fondazione Gabriele Monasterio CNR/Regione Toscana, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
Fondazione Gabriele Monasterio CNR/Regione Toscana, Pisa, Italy.
JACC Cardiovasc Imaging. 2019 Nov;12(11 Pt 1):2141-2151. doi: 10.1016/j.jcmg.2018.12.029. Epub 2019 Mar 13.
The objective of this meta-analysis was to assess the predictive value of late gadolinium enhancement (LGE) and global systolic impairment for future major adverse cardiovascular events in left ventricular noncompaction (LVNC).
The prognosis of patients with LVNC, with and without left ventricular dysfunction and LGE, is still unclear.
A systematic review of published research and a meta-analysis reporting a combined endpoint of hard (cardiac death, sudden cardiac death, appropriate defibrillator firing, resuscitated cardiac arrest, cardiac transplantation, assist device implantation) and minor (heart failure hospitalization and thromboembolic events) events was performed.
Four studies with 574 patients with LVNC and 677 with no LVNC and an average follow-up duration of 5.2 years were analyzed. In patients with LVNC, LGE was associated with the combined endpoint (pooled odds ratio: 4.9; 95% confidence interval: 1.63 to 14.6; p = 0.005) and cardiac death (pooled odds ratio: 9.8; 95% confidence interval: 2.44 to 39.5; p < 0.001). Preserved left ventricular systolic function was found in 183 patients with LVNC: 25 with positive LGE and 158 with negative LGE. In LVNC with preserved ejection fraction, positive LGE was associated with hard cardiac events (odds ratio: 6.1; 95% confidence interval: 2.1 to 17.5; p < 0.001). No hard cardiac events were recorded in patients with LVNC, preserved ejection fraction, and negative LGE.
Patients with LVNC but without LGE have a better prognosis than those with LGE. When LGE is negative and global systolic function is preserved, no hard cardiac events are to be expected. Currently available criteria allow diagnosis of LVNC, but to further define the presence and prognostic significance of the disease, LGE and/or global systolic impairment must be considered for better risk stratification.
本荟萃分析旨在评估晚期钆增强（LGE）和整体收缩功能障碍对左室心肌致密化不全（LVNC）患者未来发生主要不良心血管事件的预测价值。
伴有或不伴有左心室功能障碍和 LGE 的 LVNC 患者的预后仍不清楚。
对发表的研究进行系统评价和荟萃分析，报告了一个联合终点（硬终点：心脏性死亡、心脏性猝死、适当除颤器放电、复苏性心脏骤停、心脏移植、辅助装置植入；小终点：心力衰竭住院和血栓栓塞事件）。
分析了 4 项研究，共纳入 574 例 LVNC 患者和 677 例非 LVNC 患者，平均随访时间为 5.2 年。在 LVNC 患者中，LGE 与联合终点（合并优势比：4.9；95%置信区间：1.63 至 14.6；p=0.005）和心脏性死亡（合并优势比：9.8；95%置信区间：2.44 至 39.5；p<0.001）相关。LVNC 患者中有 183 例保留左心室收缩功能：25 例 LGE 阳性，158 例 LGE 阴性。在左室射血分数保留的 LVNC 患者中，LGE 阳性与硬终点相关（优势比：6.1；95%置信区间：2.1 至 17.5；p<0.001）。在 LVEF 保留且 LGE 阴性的 LVNC 患者中未记录到硬终点。
无 LGE 的 LVNC 患者的预后优于有 LGE 的患者。当 LGE 阴性且整体收缩功能保留时，不会发生硬终点事件。目前可用的标准允许 LVNC 的诊断，但为了进一步确定疾病的存在和预后意义，必须考虑 LGE 和/或整体收缩功能障碍，以进行更好的风险分层。
