Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Sichuan University West China Second University Hospital, Chengdu, China.
Department of Radiology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China.
BMJ Open. 2022 Jan 11;12(1):e055374. doi: 10.1136/bmjopen-2021-055374.
This meta-analysis assessed the associations of myocardial fibrosis detected by late gadolinium-enhanced (LGE)-MRI with the risk of major adverse cardiac and cerebrovascular events (MACCEs) and major adverse cardiac events (MACEs) in patients with diabetes.
Systematic review and meta-analysis reported in accordance with the guidelines of the Meta-analysis of Observational Studies in Epidemiology statement.
We searched the Medline, Embase and Cochrane by Ovid databases for studies published up to 27 August 2021.
Prospective or respective cohort studies were included if they reported the HR and 95% CIs for MACCEs/MACEs in patients with either type 1 or 2 diabetes and LGE-MRI-detected myocardial fibrosis compared with patients without LGE-MRI-detected myocardial fibrosis and if the articles were published in the English language.
Two review authors independently extracted data and assessed the quality of the included studies. Pooled HRs and 95% CIs were analysed using a random effects model. Heterogeneity was assessed using forest plots and I statistics.
Eight studies with 1121 patients with type 1 or type 2 diabetes were included in this meta-analysis, and the follow-up ranged from 17 to 70 months. The presence of myocardial fibrosis detected by LGE-MRI was associated with an increased risk for MACCEs (HR: 2.58; 95% CI 1.42 to 4.71; p=0.002) and MACEs (HR: 5.28; 95% CI 3.20 to 8.70; p<0.001) in patients with diabetes. Subgroup analysis revealed that ischaemic fibrosis detected by LGE was associated with MACCEs (HR 3.80, 95% CI 2.38 to 6.07; p<0.001) in patients with diabetes.
This study demonstrated that ischaemic myocardial fibrosis detected by LGE-MRI was associated with an increased risk of MACCEs/MACEs in patients with diabetes and may be an imaging biomarker for risk stratification. Whether LGE-MRI provides incremental prognostic information with respect to MACCEs/MACEs over risk stratification by conventional cardiovascular risk factors requires further study.
本荟萃分析评估了通过钆延迟增强（LGE）-MRI 检测到的心肌纤维化与糖尿病患者发生主要不良心脏和脑血管事件（MACCEs）和主要不良心脏事件（MACEs）的风险之间的关联。
按照观察性研究荟萃分析的流行病学报告指南进行系统评价和荟萃分析。
我们检索了 Medline、Embase 和 Cochrane 由 Ovid 数据库，以获取截至 2021 年 8 月 27 日发表的研究。
如果前瞻性或各自的队列研究报告了 1 型或 2 型糖尿病患者中 LGE-MRI 检测到的心肌纤维化与未检测到 LGE-MRI 检测到的心肌纤维化患者相比，MACCEs/MACEs 的 HR 和 95%CI，并且文章以英文发表，则将其纳入研究。
两名综述作者独立提取数据并评估纳入研究的质量。使用随机效应模型分析汇总 HR 和 95%CI。使用森林图和 I 统计量评估异质性。
本荟萃分析纳入了 8 项研究，共纳入了 1121 例 1 型或 2 型糖尿病患者，随访时间从 17 个月到 70 个月不等。LGE-MRI 检测到的心肌纤维化与 MACCEs（HR：2.58；95%CI 1.42 至 4.71；p=0.002）和 MACEs（HR：5.28；95%CI 3.20 至 8.70；p<0.001）风险增加相关。亚组分析显示，LGE 检测到的缺血性纤维化与糖尿病患者的 MACCEs（HR 3.80，95%CI 2.38 至 6.07；p<0.001）相关。
本研究表明，LGE-MRI 检测到的缺血性心肌纤维化与糖尿病患者发生 MACCEs/MACEs 的风险增加相关，可能是一种用于风险分层的影像学生物标志物。LGE-MRI 是否在 MACCEs/MACEs 方面提供了比传统心血管危险因素分层更具预后意义的信息，还需要进一步研究。
