Prognostic Value of Myocardial Scarring on CMR in Patients With Cardiac Sarcoidosis.
Prognostic Value of Myocardial Scarring on CMR in Patients With Cardiac Sarcoidosis.
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DOI：
10.1016/j.jcmg.2016.05.009
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发表时间：
2017-04
期刊：
影响因子：
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通讯作者：
Salerno M
中科院分区：
文献类型：
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作者：
Coleman GC;Shaw PW;Balfour PC Jr;Gonzalez JA;Kramer CM;Patel AR;Salerno M
本研究旨在进行系统回顾和荟萃分析，以了解心肌瘢痕形成的预后价值，这是由已知或疑似心脏结节病患者的心脏磁共振成像（CMR）晚期钆增强（LGE）所证明的。尽管CMR越来越多地用于心脏结节病的诊断，但CMR在这一人群中的预后价值尚未得到很好的描述。检索PubMed、Cochrane CENTRAL和meta-Register of Controlled Trials，寻找预后数据≥1年的CMR研究。主要终点是全因死亡率和心律失常事件（室性心律失常、ICD休克、心源性猝死）的复合结局加上随访期间的全因死亡率。通过随机效应建模生成综合效应估计。纳入10项研究，共760例患者，平均随访时间为3.0±1.1年。患者平均年龄53岁，41%为男性，95.3%为心外结节病，21.6%为心脏结节病。平均射血分数为57.8±9.1%。与无LGE的患者相比，晚期钆增强患者的全因死亡率更高（比值比[OR]: 3.06, p< 0.03），综合结局的比值更高（OR: 10.74, p< 0.00001）。LGE患者复合结果的年化事件发生率增加（11.9% vs . 1.1%; p<0.0001）。在已知或疑似心脏结节病的患者中，心脏MRI上出现晚期钆增强与全因死亡率和心律失常事件的发生率增加相关。
This study sought to perform a systematic review and meta-analysis to understand the prognostic value of myocardial scarring as evidenced by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in patients with known or suspected cardiac sarcoidosis. Although CMR is increasingly used for the diagnosis of cardiac sarcoidosis, the prognostic value of CMR has been less well described in this population. PubMed, Cochrane CENTRAL, and meta-Register of Controlled Trials were searched for CMR studies with ≥ 1 year of prognostic data. Primary end-points were all-cause mortality and a composite outcome of arrhythmogenic events (ventricular arrhythmia, ICD shock, sudden cardiac death) plus all-cause mortality during follow-up. Summary effect estimates were generated with random-effects modeling. Ten studies were included, involving a total of 760 patients with a mean follow up of 3.0 ± 1.1 years. Patients had a mean age of 53 years, 41% were male, 95.3% had known extra-cardiac sarcoidosis, and 21.6% had known cardiac sarcoidosis. The average ejection fraction was 57.8 ± 9.1%. Patients with late gadolinium enhancement had higher odds for all-cause mortality (odds ratio [OR]: 3.06, p < 0.03) and higher odds of the composite outcome (OR: 10.74, p< .00001) compared to those without LGE. Patients with LGE had an increased annualized event rate of the composite outcome (11.9% v. 1.1%; p<0.0001) In patients with known or suspected cardiac sarcoidosis, the presence of late gadolinium enhancement on cardiac MRI is associated with increased odds of both all-cause mortality and arrhythmogenic events.