Yeo Tin Mei, Chin Woon Loong Calvin, Seah Chuen Wei Alvin, Cheng Ling Jie, Lin Weiqin, Dalakoti Mayank, Foo Sik Yin Roger, Wang Wenru
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Cardiology, National Heart Centre Singapore, Singapore.
Eur J Prev Cardiol. 2025 Feb 19. doi: 10.1093/eurjpc/zwaf083.
Cardiometabolic conditions including hypertension, diabetes, hyperlipidaemia and obesity are significant risk factors for cardiovascular diseases. Myocardial fibrosis (MF) is a complication and final common pathway of these conditions, potentially leading to heart failure, arrhythmias and sudden death. Existing reviews explored pathophysiological changes and treatment of MF, but the global prevalence of MF among individuals with cardiometabolic conditions remain limited.
To evaluate the global prevalence of MF in individuals with cardiometabolic conditions and explore factors influencing its rate.
CINAHL, Cochrane Library, Embase, PubMed, ProQuest Theses and Dissertations, Scopus, and Web of Science were systematically reviewed until January 2024. Studies included individuals with hypertension, type 2 diabetes mellitus, hyperlipidaemia, and obesity, with MF prevalence assessed via biopsy or Late Gadolinium Enhancement-Cardiac Magnetic Resonance (LGE-CMR). Meta-analysis was conducted using jamovi and factors associated with MF were synthesised narratively. This review is registered on PROSPERO, CRD42024544632.
The meta-analysis included 52 articles involving 5,921 individuals. 32.7% of individuals with cardiometabolic conditions developed MF, with hypertension demonstrating the highest prevalence [35.2%(95%CI:25.5-45.0)]. Biopsy-based studies reported a higher prevalence [75.6%(95%CI:53.6-97.6)] compared to LGE-CMR studies [26.8%(95%CI:20.6-33.0)]. Key factors associated with MF included increased LV mass/LV hypertrophy, reduced LV function, and myocardial stiffness.
This first global review estimates that one-third of individuals with cardiometabolic conditions develop MF, with the rate expected to rise. Standardized CMR measures cut-offs are needed to address prevalence inconsistencies. Future research should explore MF prevalence using diverse samples, combined CMR measures, considering socio-demographic and clinical factors for more accurate estimates.
包括高血压、糖尿病、高脂血症和肥胖在内的心脏代谢疾病是心血管疾病的重要危险因素。心肌纤维化（MF）是这些疾病的一种并发症和最终共同通路，可能导致心力衰竭、心律失常和猝死。现有综述探讨了MF的病理生理变化和治疗方法，但心脏代谢疾病患者中MF的全球患病率仍然有限。
评估心脏代谢疾病患者中MF的全球患病率，并探讨影响其发生率的因素。
对CINAHL、Cochrane图书馆、Embase、PubMed、ProQuest论文与学位论文数据库、Scopus和科学网进行系统综述，直至2024年1月。研究纳入高血压、2型糖尿病、高脂血症和肥胖患者，通过活检或延迟钆增强心脏磁共振成像（LGE-CMR）评估MF患病率。使用jamovi进行荟萃分析，并对与MF相关的因素进行叙述性综合分析。本综述已在PROSPERO注册，注册号为CRD42024544632。
荟萃分析纳入52篇文章，涉及5921名个体。32.7%的心脏代谢疾病患者发生MF，其中高血压患病率最高[35.2%（95%CI：25.5-45.0）]。与基于LGE-CMR的研究[26.8%（95%CI：20.6-33.0）]相比，基于活检的研究报告的患病率更高[75.6%（95%CI：53.6-97.6）]。与MF相关的关键因素包括左心室质量增加/左心室肥厚、左心室功能降低和心肌僵硬度增加。
这项首次全球综述估计，三分之一的心脏代谢疾病患者会发生MF，且这一比例预计会上升。需要标准化的CMR测量临界值来解决患病率不一致的问题。未来的研究应使用不同样本、联合CMR测量方法来探索MF患病率，同时考虑社会人口学和临床因素以获得更准确的估计。
