Association of myocardial fibrosis detected by late gadolinium-enhanced MRI with clinical outcomes in patients with diabetes: a systematic review and meta-analysis.
Association of myocardial fibrosis detected by late gadolinium-enhanced MRI with clinical outcomes in patients with diabetes: a systematic review and meta-analysis.
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DOI：
10.1136/bmjopen-2021-055374
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发表时间：
2022-01-11
期刊：
影响因子：
2.9
通讯作者：
Guo YK
中科院分区：
文献类型：
--
作者：
Yang Z;Xu R;Wang JR;Xu HY;Fu H;Xie LJ;Yang MX;Zhang L;Wen LY;Liu H;Li H;Yang ZG;Guo YK
该荟萃分析评估了晚期钆增强(LGE)-MRI检测的心肌纤维化与糖尿病患者主要不良心脑血管事件（MACCEs）和主要不良心脏事件（mace）风险的关系。根据《流行病学观察性研究荟萃分析》的指南进行系统评价和荟萃分析报告。我们通过Ovid数据库检索Medline、Embase和Cochrane，检索截至2021年8月27日发表的研究。如果前瞻性或相应的队列研究报告了1型或2型糖尿病患者与未检测到lge - mri心肌纤维化的患者相比MACCEs/ mace的HR和95% ci，并且文章以英语发表，则纳入前瞻性或相应的队列研究。两位综述作者独立提取资料并评估纳入研究的质量。合并hr和95% ci采用随机效应模型进行分析。异质性评估采用森林样地和I2统计。这项荟萃分析纳入了8项研究，共1121例1型或2型糖尿病患者，随访时间为17至70个月。LGE-MRI检测到心肌纤维化的存在与糖尿病患者MACCEs（风险比：2.58;95% CI 1.42至4.71;p=0.002）和MACCEs（风险比：5.28;95% CI 3.20至8.70;p<0.001）的风险增加相关。亚组分析显示，糖尿病患者LGE检测到的缺血性纤维化与MACCEs相关（HR 3.80, 95% CI 2.38 ~ 6.07; p<0.001）。该研究表明，LGE-MRI检测的缺血性心肌纤维化与糖尿病患者MACCEs/ mace风险增加相关，可能是风险分层的成像生物标志物。与传统心血管危险因素的风险分层相比，LGE-MRI是否能提供MACCEs/ mace的增量预后信息还有待进一步研究。
This meta-analysis assessed the associations of myocardial fibrosis detected by late gadolinium-enhanced (LGE)-MRI with the risk of major adverse cardiac and cerebrovascular events (MACCEs) and major adverse cardiac events (MACEs) in patients with diabetes. Systematic review and meta-analysis reported in accordance with the guidelines of the Meta-analysis of Observational Studies in Epidemiology statement. We searched the Medline, Embase and Cochrane by Ovid databases for studies published up to 27 August 2021. Prospective or respective cohort studies were included if they reported the HR and 95% CIs for MACCEs/MACEs in patients with either type 1 or 2 diabetes and LGE-MRI-detected myocardial fibrosis compared with patients without LGE-MRI-detected myocardial fibrosis and if the articles were published in the English language. Two review authors independently extracted data and assessed the quality of the included studies. Pooled HRs and 95% CIs were analysed using a random effects model. Heterogeneity was assessed using forest plots and I2 statistics. Eight studies with 1121 patients with type 1 or type 2 diabetes were included in this meta-analysis, and the follow-up ranged from 17 to 70 months. The presence of myocardial fibrosis detected by LGE-MRI was associated with an increased risk for MACCEs (HR: 2.58; 95% CI 1.42 to 4.71; p=0.002) and MACEs (HR: 5.28; 95% CI 3.20 to 8.70; p<0.001) in patients with diabetes. Subgroup analysis revealed that ischaemic fibrosis detected by LGE was associated with MACCEs (HR 3.80, 95% CI 2.38 to 6.07; p<0.001) in patients with diabetes. This study demonstrated that ischaemic myocardial fibrosis detected by LGE-MRI was associated with an increased risk of MACCEs/MACEs in patients with diabetes and may be an imaging biomarker for risk stratification. Whether LGE-MRI provides incremental prognostic information with respect to MACCEs/MACEs over risk stratification by conventional cardiovascular risk factors requires further study.
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影响因子：
37.8
作者：
Kwong RY;Sattar H;Wu H;Vorobiof G;Gandla V;Steel K;Siu S;Brown KA
通讯作者：
Brown KA
影响因子：
9.3
作者：
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39.2
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影响因子：
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