Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital Hong Kong, Hong Kong, China.
Department of Medicine, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong, China.
Int J Cardiovasc Imaging. 2022 Dec;38(12):2707-2721. doi: 10.1007/s10554-022-02679-9. Epub 2022 Aug 4.
Cardiac magnetic resonance (CMR) derived left ventricular global longitudinal strain (LV-GLS) for evaluating dilated cardiomyopathy patients has been addressed in studies with contradictory results. We therefore performed the first systematic review evaluating evidence on the prognostic value of CMR derived LV-GLS for ischaemic (IDCM) and non-ischaemic dilated cardiomyopathy (NDCM) patients. Systematic review (PROSPERO CRD42020171582) identified studies up to January 2021 that measured LV-GLS for predicting major adverse cardiac events among dilated cardiomyopathy patients. Studies were identified from MEDLINE, Embase and PubMed by two independent reviewers. 2099 studies were screened. Three prospective and three retrospective observational studies comprising of 1758 patients (29% IDCM patients; 71% NDCM patients) with a weighted mean follow up of 3 years (SD = 1 year) were identified. All six studies included mortality in the primary composite outcome. LV-GLS was associated with increase primary composite outcome among mild to moderately impaired left ventricular ejection fraction (LVEF) IDCM and NDCM patients (> 30%) in univariable and multivariable analysis. Association was lost among severely impaired LVEF patients (< 30%). From sensitivity analysis, LV-GLS showed significant association with death among NDCM patients (HR 1.27; 95% CI 1.10-1.46; p = 0.001; I = 59%) but insignificant for heart transplant outcome (HR 1.23; 95% CI 0.46-3.33; p = 0.68, I = 44%). LV-GLS threshold for effectively stratifying patients is - 12.5% to - 13.5%. LVEF in IDCM and NDCM became an insignificant prognostic marker in multivariable analysis. CMR LV-GLS shows promise as an independent predictor of mortality in IDCM and NDCM patients. However, in patients with LVEF < 30% LV-GLS may have less prognostic value.Prospero Registration: CRD42020171582.
心脏磁共振(CMR)衍生的左心室整体纵向应变(LV-GLS)用于评估扩张型心肌病患者,在研究中得到了不同的结果。因此,我们进行了首次系统评价,评估 CMR 衍生的 LV-GLS 对缺血性(IDCM)和非缺血性扩张型心肌病(NDCM)患者的预后价值的证据。系统评价(PROSPERO CRD42020171582)确定了截至 2021 年 1 月测量 LV-GLS 以预测扩张型心肌病患者主要不良心脏事件的研究。研究由两名独立审查员从 MEDLINE、Embase 和 PubMed 中确定。共筛选了 2099 项研究。确定了三项前瞻性和三项回顾性观察性研究,共纳入 1758 例患者(29%为 IDCM 患者;71%为 NDCM 患者),加权平均随访时间为 3 年(标准差=1 年)。所有六项研究均将主要复合结局中的死亡纳入主要复合结局。在单变量和多变量分析中,LV-GLS 与轻度至中度左心室射血分数(LVEF)受损的 IDCM 和 NDCM 患者(>30%)的主要复合结局增加相关。在严重 LVEF 受损的患者(<30%)中,这种关联消失了。从敏感性分析中,LV-GLS 显示与 NDCM 患者的死亡有显著关联(HR 1.27;95%CI 1.10-1.46;p=0.001;I=59%),但与心脏移植结局无关(HR 1.23;95%CI 0.46-3.33;p=0.68,I=44%)。LV-GLS 有效分层患者的阈值为-12.5%至-13.5%。在多变量分析中,IDCM 和 NDCM 的 LVEF 成为无意义的预后标志物。CMR LV-GLS 有望成为 IDCM 和 NDCM 患者死亡率的独立预测因子。然而,在 LVEF<30%的患者中,LV-GLS 的预后价值可能较低。Prospero 注册:CRD42020171582。