Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia.
Department of Cardiology, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia; Western Sydney University, Sydney. NSW, Australia.
Int J Cardiol. 2022 Sep 15;363:225-239. doi: 10.1016/j.ijcard.2022.06.047. Epub 2022 Jun 18.
The presence of myocardial late gadolinium enhancement (LGE) indicates myocyte necrosis, and assists with the diagnosis of acute myocarditis (AM). Cardiac magnetic resonance (CMR) measures other than LGE i.e. tissue characterization and myocardial structural and functional parameters, play an important diagnostic role in assessment for inflammation, as seen in AM. The aim of this systematic review was to appraise the evidence for the use of quantitative CMR measures to identify myocardial inflammation in order to diagnose AM in adult patients.
A systematic literature search of medical databases was performed using PRISMA principles to identify relevant CMR studies on AM in adults (2005-2020; English; PROSPERO registration CRD42020180605). Data for a range of quantitative CMR measures were extracted. Continuous variables with low heterogeneity were meta-analyzed using a random-effects model for overall effect size measured as the standard mean difference (SMD).
Available data from 25 studies reporting continuous quantitative 1.5-T CMR measures revealed that AM is most reliably differentiated from healthy controls using T1 mapping (SMD 1.80, p<0.01) and T2 mapping (SMD 1.63, p<0.01), respectively. All other measures examined including T2-weighted ratio, extracellular volume, early gadolinium enhancement ratio, right ventricular ejection fraction, and LV end-diastolic volume, mass, ejection fraction, longitudinal strain, circumferential strain, and radial strain also had discriminatory ability although with smaller standard mean difference values (|SMD| 0.32-0.96, p < 0.01 for all).
Meta-analysis shows that myocardial tissue characterization (T1 mapping>T2 mapping) followed by measures of left ventricular structure and function demonstrate diagnostic discriminatory ability in AM.
心肌延迟钆增强（LGE）的存在表明心肌坏死，并有助于急性心肌炎（AM）的诊断。心脏磁共振（CMR）除 LGE 以外的其他测量，即组织特征和心肌结构和功能参数，在评估 AM 中的炎症方面具有重要的诊断作用。本系统评价旨在评估使用定量 CMR 测量来识别心肌炎症以诊断成人 AM 的证据。
使用 PRISMA 原则对医学数据库进行系统文献检索，以确定有关成人 AM 的 CMR 研究（2005-2020 年；英语；PROSPERO 注册 CRD42020180605）。提取了一系列定量 CMR 测量值的数据。使用随机效应模型对具有低异质性的连续变量进行荟萃分析，以测量总效应大小作为标准均数差（SMD）。
来自 25 项研究的可用数据报告了连续的定量 1.5-T CMR 测量值，结果表明，T1 映射（SMD 1.80，p<0.01）和 T2 映射（SMD 1.63，p<0.01）分别最可靠地将 AM 与健康对照组区分开来。检查的所有其他措施，包括 T2 加权比、细胞外容积、早期钆增强比、右心室射血分数和 LV 舒张末期容积、质量、射血分数、纵向应变、周向应变和径向应变，也具有鉴别能力，尽管 SMD 值较小（|SMD| 0.32-0.96，p<0.01）。
荟萃分析表明，心肌组织特征（T1 映射>T2 映射），其次是左心室结构和功能的测量，在 AM 中具有诊断鉴别能力。
