School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom (G.G., S.F., A.C., P.G.M., T.F.I.).
Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece (G.G., K.S.).
Circ Cardiovasc Imaging. 2021 Jan;14(1):e011492. doi: 10.1161/CIRCIMAGING.120.011492. Epub 2021 Jan 14.
Patients with acute myocarditis (AM) are at increased risk of adverse cardiac events after the index episode. Late gadolinium enhancement (LGE) detected by cardiovascular magnetic resonance in patients with AM plays an important diagnostic role, but its prognostic significance remains unresolved. This systematic review and meta-analysis sought to assess the prognostic implications of cardiovascular magnetic resonance-derived LGE in patients with AM.
Data search was conducted from inception through February 28, 2020, using the following Medical Subject Heading terms: . From 2422 articles retrieved, we selected 11 studies reporting baseline cardiovascular magnetic resonance assessment and long-term clinical follow-up in patients with AM. Hazard ratios and CIs for a combined clinical end point were recorded for LGE presence, extent (>2 segments or >10% of left ventricular [LV] mass or >17g) and location (anteroseptal versus non-anteroseptal). A combined end point comprised all-cause mortality, cardiac mortality, and major adverse cardiovascular events. Hartung and Knapp correction improved robustness of the results. Prespecified sensitivity analyses explored potential sources of heterogeneity. The meta-analysis was conducted according to the Meta-analysis of Observational Studies in Epidemiology guidelines.
LGE presence (pooled hazard ratios, 3.28 [95% CIs, 1.69-6.39], <0.001 [95% CIs, 1.33-8.11] after Hartung and Knapp correction) and anteroseptal LGE (pooled-hazard ratios, 2.58 [95% CIs, 1.87-3.55], <0.001 [95% CIs, 1.64-4.06] after Hartung and Knapp correction) were associated with an increased risk of the combined end point. Extensive LGE was associated with worse outcomes (pooled-hazard ratios, 1.96 [95% CIs, 1.08-3.56], =0.027), but this association was not confirmed after Hartung and Knapp correction (95% CIs, 0.843-4.57).
LGE presence and anteroseptal location at baseline cardiovascular magnetic resonance are important independent prognostic markers that herald an increased risk of adverse cardiac outcomes in patients with AM. Registration: https://www.crd.york.ac.uk/PROSPERO/ Unique identifier: CRD42019146619.
急性心肌炎（AM）患者在首发事件后发生不良心脏事件的风险增加。心血管磁共振检测到的 AM 患者的晚期钆增强（LGE）在诊断中具有重要作用，但其预后意义仍未解决。本系统评价和荟萃分析旨在评估 AM 患者心血管磁共振衍生 LGE 的预后意义。
从 2020 年 2 月 28 日开始进行数据搜索，使用以下医学主题词：。从 2422 篇文章中，我们选择了 11 项研究，这些研究报告了 AM 患者的基线心血管磁共振评估和长期临床随访结果。记录 LGE 存在、范围（>2 个节段或>10%的左心室[LV]质量或>17g）和位置（前间隔与非前间隔）的合并临床终点的风险比和置信区间。复合终点包括全因死亡率、心脏死亡率和主要不良心血管事件。哈通和纳普校正提高了结果的稳健性。预先指定的敏感性分析探讨了异质性的潜在来源。荟萃分析根据观察性研究的荟萃分析流行病学指南进行。
LGE 存在（合并危险比，3.28 [95%置信区间，1.69-6.39]，<0.001 [95%置信区间，1.33-8.11]，经哈通和纳普校正）和前间隔 LGE（合并危险比，2.58 [95%置信区间，1.87-3.55]，<0.001 [95%置信区间，1.64-4.06]，经哈通和纳普校正）与复合终点的风险增加相关。广泛的 LGE 与预后不良相关（合并危险比，1.96 [95%置信区间，1.08-3.56]，=0.027），但经哈通和纳普校正后，这种相关性未得到证实（95%置信区间，0.843-4.57）。
基线心血管磁共振上 LGE 的存在和前间隔位置是重要的独立预后标志物，预示着 AM 患者不良心脏结局的风险增加。注册：https://www.crd.york.ac.uk/PROSPERO/ 唯一标识符：CRD42019146619。
