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系统评价和荟萃分析心肌磁共振应变预测心脏结局的价值。

Systematic review and meta-analysis for the value of cardiac magnetic resonance strain to predict cardiac outcomes.

机构信息

Departments of Cardiology, Vascular Medicine and Pneumology, GRN Academic Teaching Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.

Cardiac Imaging Center Weinheim, Hector Foundations, Weinheim, Germany.

出版信息

Sci Rep. 2024 Jan 11;14(1):1094. doi: 10.1038/s41598-023-50835-5.

Abstract

Cardiac magnetic resonance (CMR) is the gold standard for the diagnostic classification and risk stratification in most patients with cardiac disorders. The aim of the present study was to investigate the ability of Strain-encoded MR (SENC) for the prediction of major adverse cardiovascular events (MACE). A systematic review and meta-analysis was performed according to the PRISMA Guidelines, including patients with or without cardiovascular disease and asymptomatic individuals. Myocardial strain by HARP were used as pulse sequences in 1.5 T scanners. Published literature in MEDLINE (PubMed) and Cochrane's databases were explored before February 2023 for studies assessing the clinical utility of myocardial strain by Harmonic Phase Magnetic Resonance Imaging (HARP), Strain-encoded MR (SENC) or fast-SENC. In total, 8 clinical trials (4 studies conducted in asymptomatic individuals and 4 in patients with suspected or known cardiac disease) were included in this systematic review, while 3 studies were used for our meta-analysis, based on individual patient level data. Kaplan-Meier analysis and Cox proportional hazard models were used, testing the ability of myocardial strain by HARP and SENC/fast-SENC for the prediction of MACE. Strain enabled risk stratification in asymptomatic individuals, predicting MACE and the development of incident heart failure. Of 1332 patients who underwent clinically indicated CMR, including SENC or fast-SENC acquisitions, 19 patients died, 28 experienced non-fatal infarctions, 52 underwent coronary revascularization and 86 were hospitalized due to heart failure during median 22.4 (17.2-28.5) months of follow-up. SENC/fast-SENC, predicted both all-cause mortality and MACE with high accuracy (HR = 3.0, 95% CI = 1.2-7.6, p = 0.02 and HR = 4.1, 95% CI = 3.0-5.5, respectively, p < 0.001). Using hierarchical Cox-proportional hazard regression models, SENC/fast-SENC exhibited incremental value to clinical data and conventional CMR parameters. Reduced myocardial strain predicts of all-cause mortality and cardiac outcomes in symptomatic patients with a wide range of ischemic or non-ischemic cardiac diseases, whereas in asymptomatic individuals, reduced strain was a precursor of incident heart failure.

摘要

心脏磁共振(CMR)是大多数心脏疾病患者诊断分类和风险分层的金标准。本研究旨在探讨应变编码磁共振(SENC)预测主要不良心血管事件(MACE)的能力。根据 PRISMA 指南,对包括有或无心血管疾病和无症状个体的患者进行了系统评价和荟萃分析。在 1.5T 扫描仪中使用 HARP 进行心肌应变。在 2023 年 2 月之前,在 MEDLINE(PubMed)和 Cochrane 数据库中搜索评估 Harmonic Phase Magnetic Resonance Imaging(HARP)、应变编码磁共振(SENC)或快速 SENC 心肌应变的临床实用性的文献,以评估心肌应变的临床实用性。本系统评价共纳入 8 项临床试验(4 项在无症状个体中进行,4 项在疑似或已知心脏疾病患者中进行),其中 3 项研究基于个体患者水平数据用于荟萃分析。使用 Kaplan-Meier 分析和 Cox 比例风险模型,测试 HARP 和 SENC/fast-SENC 心肌应变预测 MACE 的能力。应变能够对无症状个体进行风险分层,预测 MACE 和心力衰竭的发生。在接受临床指征性 CMR 检查的 1332 名患者中,包括 SENC 或快速 SENC 采集,19 名患者死亡,28 名患者发生非致死性梗死,52 名患者接受冠状动脉血运重建,86 名患者因心力衰竭住院,中位随访时间为 22.4(17.2-28.5)个月。SENC/fast-SENC 可准确预测全因死亡率和 MACE(HR=3.0,95%CI=1.2-7.6,p=0.02 和 HR=4.1,95%CI=3.0-5.5,分别,p<0.001)。使用分层 Cox 比例风险回归模型,SENC/fast-SENC 显示出对临床数据和常规 CMR 参数的增量价值。在患有广泛缺血性或非缺血性心脏疾病的有症状患者中,心肌应变降低可预测全因死亡率和心脏结局,而在无症状个体中,应变降低是心力衰竭事件的前兆。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f6de/10784294/5b05298366c6/41598_2023_50835_Fig1_HTML.jpg

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