Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan, 610041, China.
Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
ESC Heart Fail. 2020 Oct;7(5):2184-2192. doi: 10.1002/ehf2.12865. Epub 2020 Jun 30.
Identification of patients with non-ischaemic dilated cardiomyopathy (NICM) who are at risk of sudden cardiac death (SCD) and could benefit from an implantable cardioverter defibrillator (ICD) is challenging. The study aims to systematically assess the prognostic value of left ventricular (LV) midwall late gadolinium enhancement (LGE) pattern in patients with NICM and further explore its value on predicting SCD events. The study was prospectively registered in PROPSERO (CRD42019138468). We systematically searched PubMed, Ovid Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov to identify studies that evaluated the association between LV midwall LGE and clinical outcomes (all-cause mortality, cardiovascular mortality, and SCD or aborted SCD endpoint) in NICM patients. A meta-analysis was performed to determine pooled odds ratio (OR) for these adverse events. Seven studies including 1827 NICM patients over a mean follow-up duration of 36.1 ± 19.3 months were included. The presence of LV midwall LGE pattern was observed in 562 (30.8%) patients. The pooled OR was 3.37 [95% confidence intervals (CIs): 1.35-8.42] for all-cause mortality, 5.56 (95% CI: 1.23-25.22) for cardiovascular mortality, and 2.25 (95% CI: 1.16-3.16) for SCD or aborted SCD. In a subgroup analysis with mean ejection fraction cut-off point of 35%, the pooled OR for SCD or aborted SCD was 2.06 (95% CI: 1.32-3.22) for LV ejection fraction (LVEF) > 35% and 2.49 (95% CI: 1.48-4.20) for LVEF ≤ 35%. In addition, our study indicated that LV midwall LGE showed an excellent negative predictive value in identifying high-risk NICM patients and that the number needed to treat with ICD implantation in NICM patients with midwall LGE is 7. The presence of LV midwall on LGE is a significant prognosticator of adverse events in NICM patients. Additionally, patients with LV midwall LGE may be considered for ICD therapy irrespective of LVEF.
识别有发生非缺血性扩张型心肌病（NICM）相关心源性猝死（SCD）风险并可能从植入式心脏复律除颤器（ICD）获益的患者极具挑战性。本研究旨在系统评估 NICM 患者左心室（LV）中层晚期钆增强（LGE）模式的预后价值，并进一步探讨其预测 SCD 事件的价值。本研究前瞻性地在 PROPSERO（CRD42019138468）上注册。我们系统地检索了 PubMed、Ovid Embase、Cochrane 图书馆、Web of Science 和 ClinicalTrials.gov，以确定评估 LV 中层 LGE 与 NICM 患者临床结局（全因死亡率、心血管死亡率和 SCD 或 SCD 未遂终点）之间关联的研究。进行荟萃分析以确定这些不良事件的汇总优势比（OR）。纳入了 7 项研究，共纳入 1827 例 NICM 患者，平均随访时间为 36.1±19.3 个月。562（30.8%）例患者存在 LV 中层 LGE 模式。汇总的 OR 分别为全因死亡率 3.37[95%置信区间（CI）：1.35-8.42]、心血管死亡率 5.56（95%CI：1.23-25.22）和 SCD 或 SCD 未遂 2.25（95%CI：1.16-3.16）。在以平均射血分数截断点为 35%的亚组分析中，LV 射血分数（LVEF）＞35%的 SCD 或 SCD 未遂的汇总 OR 为 2.06（95%CI：1.32-3.22），LVEF≤35%的汇总 OR 为 2.49（95%CI：1.48-4.20）。此外，本研究表明，LV 中层 LGE 在识别高危 NICM 患者方面具有极好的阴性预测值，且在有 LV 中层 LGE 的 NICM 患者中，需要 ICD 植入治疗的数量为 7。LGE 中存在 LV 中层是 NICM 患者不良事件的重要预测因子。此外，无论 LVEF 如何，有 LV 中层 LGE 的患者均可考虑 ICD 治疗。
