Figliozzi Stefano, Stankowski Kamil, Di Maio Silvana, Pateras Konstantinos, Rojanathagoon Thanakorn, Marchenko Oksana, Stylianidis Vasileios, Francone Marco, Monti Lorenzo, Cavalcante João L, Georgiopoulos Georgios, Masci Pier Giorgio
Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Radiol Cardiothorac Imaging. 2025 Jun;7(3):e240313. doi: 10.1148/ryct.240313.
Purpose To determine the prognostic significance of cardiac MRI parameters in patients with moderate-to-severe aortic regurgitation (AR) and minimal or no symptoms through a network meta-analysis. Materials and Methods This systematic review and network meta-analysis searched in PubMed, Embase, and Cochrane Library databases for articles published from January 1, 2000, to March 1, 2024, investigating the prognostic value of cardiac MRI parameters in patients with moderate-to-severe AR. The composite outcome included all-cause death, heart failure hospitalization, aortic valve replacement, new-onset heart failure symptoms, New York Heart Association class progression, and left ventricular ejection fraction less than 50%. Both pairwise and network meta-analyses were performed. Results Eight studies with 1579 patients (1187 male patients [75%]; mean age, 55 years ± 5 [SD]) were included. Aortic regurgitant volume and regurgitant fraction were associated with a higher incidence of adverse events (pooled hazard ratio [HR], 1.04 per 1 mL increase [95% CI: 1.01, 1.06] and pooled HR, 1.09 per 1% increase [95% CI: 1.03, 1.16], respectively). Adverse remodeling, reflected by increased end-diastolic or end-systolic volume (pooled HR, 1.02 per 1 mL/m [95% CI: 1.01, 1.03] and pooled HR, 1.02 per 1 mL/m [95% CI: 1.01, 1.04], respectively), was predictive of worse outcome. Late gadolinium enhancement was associated with a twofold increased risk of developing the study end point (pooled HR, 1.86; 95% CI: 1.20, 2.89). T1 mapping and extracellular volume could not be assessed. Network meta-analysis disclosed that late gadolinium enhancement ( = .884) and regurgitant fraction ( = .727) were the most important prognostic factors. Conclusion This network meta-analysis demonstrated the strong prognostic value of regurgitant fraction and left ventricular adverse remodeling as assessed with cardiac MRI in risk stratification of patients with moderate-to-severe AR and no or minimal symptoms. Meta-Analysis, Aortic Regurgitation, Late Gadolinium Enhancement, Cardiac MRI © RSNA, 2025.
目的 通过网络荟萃分析确定心脏磁共振成像（MRI）参数对中重度主动脉瓣反流（AR）且症状轻微或无症状患者的预后意义。材料与方法 本系统评价和网络荟萃分析在PubMed、Embase和Cochrane图书馆数据库中检索2000年1月1日至2024年3月1日发表的文章，调查心脏MRI参数对中重度AR患者的预后价值。复合结局包括全因死亡、心力衰竭住院、主动脉瓣置换、新发心力衰竭症状、纽约心脏协会分级进展以及左心室射血分数低于50%。进行了成对和网络荟萃分析。结果 纳入8项研究，共1579例患者（1187例男性患者[75%]；平均年龄55岁±5[标准差]）。主动脉反流容积和反流分数与不良事件发生率较高相关（每增加1 mL的合并风险比[HR]为1.04[95%置信区间：1.01, 1.06]，每增加1%的合并HR为1.09[95%置信区间：1.03, 1.16]）。以舒张末期或收缩末期容积增加反映的不良重塑（每增加1 mL/m的合并HR分别为1.02[95%置信区间：1.01, 1.03]和每增加1 mL/m的合并HR为1.02[95%置信区间：1.01, 1.04]）可预测更差的结局。钆延迟增强与发生研究终点的风险增加两倍相关（合并HR，1.86；95%置信区间：1.20, 2.89）。无法评估T1映射和细胞外容积。网络荟萃分析显示钆延迟增强（ = 0.884）和反流分数（ = 0.727）是最重要的预后因素。结论 本网络荟萃分析表明，心脏MRI评估的反流分数和左心室不良重塑在中重度AR且无症状或症状轻微患者的风险分层中具有很强的预后价值。荟萃分析、主动脉瓣反流、钆延迟增强、心脏MRI © RSNA，2025年
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