Department of Cardiology, Yokohama Hodogaya Central Hospital, Kanagawa, Japan.
Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
Int J Cardiovasc Imaging. 2024 Aug;40(8):1797-1807. doi: 10.1007/s10554-024-03191-y. Epub 2024 Jul 16.
The prognostic implications of late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI) in the context of cardiac sarcoidosis (CS) have attracted considerable attention. Nevertheless, a subset of studies has undistinguished confirmed and suspected CS cases, thereby engendering interpretative ambiguities. In this meta-analysis, we evaluated the differences in cardiac MRI findings and their prognostic utility between confirmed and suspected CS. A literature search was conducted using PubMed, Web of Science, and Cochrane libraries to compare the findings of cardiac MRI and its prognostic value in CS and suspected CS. A meta-analysis was performed to compare the prevalence of LGE MRI, odds ratios, and hazard ratios for predicting cardiac events in both groups. A total of 21 studies encompassing 24 different populations were included in the meta-analysis (CS: 393 cases, suspected CS: 2151 cases). CS had a higher frequency of LGE of the left ventricle (87.2% vs. 36.4%, p < 0.0001) and right ventricle (62.1% vs. 23.8%, p = 0.04) than suspected CS. In patients with suspected CS, the presence of left ventricular LGE was associated with higher all-cause mortality [odds ratio: 5.70 (95%CI: 2.51-12.93), p < 0.0001, I = 8%, p for heterogeneity = 0.37] and ventricular arrhythmia [odds ratio: 15.51 (95%CI: 5.65-42.55), p < 0.0001, I = 0, p for heterogeneity = 0.94]. In contrast, in CS, not the presence but extent of left ventricular LGE was a significant predictor of outcome (hazard ratio = 1.83 per 10% increase of %LGE (95%CI: 1.43-2.34, p < 0.001, I = 15, p for heterogeneity = 0.31). The presence of left ventricular LGE was a strong prognostic factor in suspected sarcoidosis. However, the extremely high prevalence of left ventricular LGE in confirmed CS suggests that the quantitative assessment of LGE is useful for prognostic estimation.
心脏结节病（CS）中晚期钆增强（LGE）磁共振成像（MRI）的预后意义引起了广泛关注。然而，一些研究没有区分确诊和疑似 CS 病例，从而产生了解释上的歧义。在这项荟萃分析中，我们评估了确诊和疑似 CS 患者心脏 MRI 检查结果及其预后价值的差异。使用 PubMed、Web of Science 和 Cochrane 图书馆进行文献检索，比较 CS 和疑似 CS 患者心脏 MRI 检查结果及其预后价值。对两组 LGE MRI 患病率、比值比和风险比进行荟萃分析，以预测心脏事件。荟萃分析共纳入 21 项研究，涵盖 24 个不同人群（CS：393 例，疑似 CS：2151 例）。CS 患者左心室（87.2%比 36.4%，p<0.0001）和右心室（62.1%比 23.8%，p=0.04）LGE 的发生率均高于疑似 CS。在疑似 CS 患者中，左心室 LGE 的存在与全因死亡率增加相关[比值比：5.70（95%CI：2.51-12.93），p<0.0001，I=8%，p 异质性=0.37]和室性心律失常[比值比：15.51（95%CI：5.65-42.55），p<0.0001，I=0，p 异质性=0.94]。相比之下，在 CS 中，不是左心室 LGE 的存在，而是其程度是预后的重要预测因素（每增加 10%的 LGE，风险比=1.83（95%CI：1.43-2.34，p<0.001，I=15，p 异质性=0.31）。左心室 LGE 的存在是疑似结节病的一个强烈预后因素。然而，确诊 CS 患者中左心室 LGE 的极高患病率表明，LGE 的定量评估对预后估计有用。
