晚期钆增强在预测植入式心脏复律除颤器治疗的心力衰竭患者危及生命的心律失常中的预后价值：一项系统评价和荟萃分析。

Prognostic Value of Late Gadolinium Enhancement in Predicting Life-Threatening Arrhythmias in Heart Failure Patients With Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis.

作者信息

Yue Ting, Chen Bing-Hua, Wu Lian-Ming, Xu Jian-Rong, Pu Jun

机构信息

Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

J Magn Reson Imaging. 2020 May;51(5):1422-1439. doi: 10.1002/jmri.26982. Epub 2019 Nov 11.

DOI:10.1002/jmri.26982

PMID:31710415

Abstract

BACKGROUND

The presence of late gadolinium enhanced (LGE), which may enable better evaluation of myocardial impairment, would help predict the occurrence of life-threatening arrhythmias and major adverse cardiovascular events (MACE) in patients suffering from ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM) patients and who underwent a process of implantable cardioverter-defibrillator (ICD).

PURPOSE

To evaluate the prognostic value of cardiac MR-LGE for ICM and NICM patients with ICD.

STUDY TYPE

Systematic review and meta-analysis.

POPULATION

A total of 33 studies of 3457 patients were included.

FIELD STRENGTH

5T and 3.0T, LGE.

ASSESSMENT

PubMed, Cochrane Library, EMBASE, and Web of Science were systematically searched for studies reporting LGE in ICM or NICM patients with ICD implantation with several kinds of endpoints: MACE, life-threatening arrhythmia, cardiovascular mortality, and all-cause mortality.

STATISTICAL TESTS

A meta-analysis was performed using a random-effects model to calculate odds ratios or standard mean differences (SMDs) for binary and continuous data.

RESULTS

MR-LGE was positive in 1923 (55.6%) of ICM and NICM patients. LGE-present patients were more likely to have life-threatening arrhythmia (odds ratio [OR]: 5.1; 95% confidence interval [CI]: 3.8-6.8), MACE (OR: 5.2; 95% CI: 3.8-6.9), cardiovascular mortality (OR: 2.4; 95% CI: 1.2-4.6), and all-cause mortality (OR: 2.1; 95% CI: 1.3-3.4) compared with those without LGE. Moreover, ICM and NICM patients with LGE both had increased life-threatening arrhythmia (OR: 4.6; 95% CI: 2.7-8.0; OR: 5.2; 95% CI: 3.6-7.8, respectively) and MACE (OR: 4.7; 95% CI: 2.8-7.9; OR: 4.7; 95% CI: 2.7-8.1, respectively).

DATA CONCLUSION

The presence of MR-LGE may worsen the prognosis for adverse cardiovascular events in both ICM and NIMC patients who benefit more from ICDs.

LEVEL OF EVIDENCE

3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1422-1439.

摘要

背景

延迟钆增强（LGE）的存在有助于更好地评估心肌损伤，这将有助于预测缺血性心肌病（ICM）和非缺血性心肌病（NICM）患者以及接受植入式心脏复律除颤器（ICD）治疗的患者发生危及生命的心律失常和主要不良心血管事件（MACE）的情况。

目的

评估心脏磁共振延迟钆增强（MR-LGE）对植入ICD的ICM和NICM患者的预后价值。

研究类型

系统评价和荟萃分析。

研究对象

共纳入33项研究，涉及3457例患者。

场强

1.5T和3.0T，LGE。

评估方法

系统检索PubMed、Cochrane图书馆、EMBASE和科学网，查找报告植入ICD的ICM或NICM患者LGE情况的研究，研究终点包括：MACE、危及生命的心律失常、心血管死亡率和全因死亡率。

统计分析

采用随机效应模型进行荟萃分析以计算二分类和连续性数据的比值比或标准化均数差（SMD）。

结果

ICM和NICM患者中1923例（55.6%）MR-LGE呈阳性。与无LGE的患者相比，存在LGE的患者更易发生危及生命的心律失常（比值比[OR]：5.1；95%置信区间[CI]：3.8 - 6.8）、MACE（OR：5.2；95% CI：3.8 - 6.9）、心血管死亡率（OR：2.4；95% CI：1.2 - 4.6）和全因死亡率（OR：2.1；95% CI：1.3 - 3.4）。此外，ICM和NICM有LGE的患者发生危及生命的心律失常（OR分别为：4.6；95% CI：2.7 - 8.0；OR：5.2；95% CI：3.6 - 7.8）和MACE（OR分别为：4.7；95% CI：2.8 - 7.9；OR：4.7；95% CI：2.7 - 8.1）的可能性均增加。