Myocardial Fibrosis Assessment by LGE Is a Powerful Predictor of Ventricular Tachyarrhythmias in Ischemic and Nonischemic LV Dysfunction A Meta-Analysis
Myocardial Fibrosis Assessment by LGE Is a Powerful Predictor of Ventricular Tachyarrhythmias in Ischemic and Nonischemic LV Dysfunction A Meta-Analysis
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DOI：
10.1016/j.jcmg.2016.01.033
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发表时间：
2016-09-01
影响因子：
14
通讯作者：
Ravelli, Flavia
中科院分区：
文献类型：
--
作者：
Disertori, Marcello;Rigoni, Marta;Ravelli, Flavia
作者进行了一项荟萃分析，以评价晚期钆增强（LGE）心脏磁共振对缺血性心肌病（ICM）和非缺血性心肌病（NICM）伴心室功能不全患者室性快速性心律失常的预测价值。最近的几项研究已经描述了LGE对室性快速性心律失常的预测价值;方法系统检索MEDLINE和科克伦图书馆电子数据库，以确定在ICM和NICM患者中应用LGE治疗心室功能不全并报道了心脏病临床结局的研究（猝死、流产猝死、室性心动过速、室颤和适当的植入式心律转复除颤器[ICD]治疗，包括抗心动过速起搏）。进行Meta分析，以确定合并优势比（OR）为这些mammic events.Results十九项研究，评估了2,850例患者423 mammic事件超过平均/中位数随访2.8年确定。23.9%的LGE试验阳性患者（年事件发生率为8.6%）达到复合终点，而4.9%的LGE试验阴性患者（年事件发生率为1.7%; P < 0.0001）达到复合终点。在不同的患者组中，LGE与血液事件相关。在总体人群中，合并OR为5.62（95%置信区间[CI]：4.20 - 7.51），ICM和NICM患者之间无显著差异。在11项研究（1，178例患者）的亚组中，平均射血分数（EF）
OBJECTIVES The authors performed a meta-analysis to evaluate the predictive value of late gadolinium enhancement (LGE) cardiac magnetic resonance for ventricular tachyarrhythmia in ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM) patients with ventricular dysfunction.BACKGROUND The use of LGE to detect myocardial fibrosis and its related arrhythmic substrate is well established. Several recent studies have described the predictive value of LGE for ventricular tachyarrhythmias; however, their validity is limited by small sample size and low number of events.METHODS MEDLINE and the Cochrane Library electronic databases were systematically searched to identify studies that applied LGE in ICM and NICM patients with ventricular dysfunction and reported arrhythmic clinical outcomes (sudden death, aborted sudden death, ventricular tachycardia, ventricular fibrillation, and appropriate implantable cardioverter-defibrillator [ICD] therapy, including antitachycardia pacing). A meta analysis was performed to determine pooled odds ratios (ORs) for these arrhythmic events.RESULTS Nineteen studies that evaluated 2,850 patients with 423 arrhythmic events over a mean/median follow-up of 2.8 years were identified. The composite arrhythmic endpoint was reached in 23.9% of patients with a positive LGE test (annualized event rate of 8.6%) versus 4.9% of patients with a negative LGE test (annualized event rate of 1.7%; P < 0.0001). LGE correlated with arrhythmic events in the different Patient grouPs. In the overall population, the pooled OR was 5.62 (95% confidence interval [CI]: 4.20 to 7.51), with no significant differences between ICM and NICM patients. In a subgroup of 11 studies (1,178 patients) with mean ejection fraction (EF)