Background

Previous studies suggest that late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is associated with arrhythmic events in patients with nonischemic cardiomyopathy (NICM), while others have questioned the role of left ventricular ejection fraction (LVEF) as a sole predictor of future events.

Objectives

To evaluate the role of LGE on CMR in identifying patients with NICM and reduced LVEF for whom a benefit from defibrillator implantation for primary prevention is not anticipated, thus they are mainly exposed to potential risks.

Methods

Major electronic databases were searched for studies reporting the incidence of appropriate device therapy (ADT), sudden cardiac death (SCD), and cardiac death based on the presence of LGE on CMR, among patients with NICM and reduced LVEF, implanted with a cardioverter defibrillator for primary prevention.

Results

Eleven studies (1652 patients, 947 with LGE) were included in the final analysis. LGE presence was strongly associated with ADT (logOR: 1.95, 95%CI: 1.21–2.69) and cardiac death (logOR: 0.91, 95%CI: 0.14–1.68), but not with SCD (logOR: 0.26, 95%CI: −1.09–1.6). Diagnostic accuracy analysis demonstrated that contrast enhancement is a sensitive marker of future ADT and cardiac death (93%, 95%CI: 85.8–96.7%; 82.9%, 95%CI: 70.6–90.7%; respectively), with moderate specificity ( 44%, 95%CI: 27.2–62.6%; 37.7%, 95%CI: 23.4–54.6%; respectively).

Conclusion

LGE is a highly sensitive predictor of ADT and cardiac death in NICM patients implanted with a defibrillator for primary prevention. However, due to moderate specificity, derivation of a cutoff with adequate predictive values and probably a multifactorial approach are needed to improve discrimination of patients who will not benefit from ICDs.

中文翻译：

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晚期钆增强对非缺血性心肌病和射血分数降低患者心脏磁共振的预后作用，植入心脏复律除颤器进行一级预防。系统评价和荟萃分析

背景

先前的研究表明，心脏磁共振 (CMR) 的晚期钆增强 (LGE) 与非缺血性心肌病 (NICM) 患者的心律失常事件相关，而其他人则质疑左心室射血分数 (LVEF) 作为心律失常的唯一预测因子​​的作用。未来的事件。

目标

评估 LGE 在 CMR 中的作用，以识别出 NICM 和 LVEF 降低的患者，这些患者预计不会从植入除颤器进行一级预防中获益，因此他们主要面临潜在风险。

方法

在主要电子数据库中搜索了报告适当设备治疗 (ADT)、心源性猝死 (SCD) 和基于 CMR 上存在 LGE 的心源性死亡的研究，这些研究在植入心脏复律除颤器的 NICM 和 LVEF 降低的患者中用于一级预防。

结果

11 项研究（1652 名患者，947 名 LGE）被纳入最终分析。LGE 的存在与 ADT (logOR: 1.95, 95%CI: 1.21–2.69) 和心源性死亡 (logOR: 0.91, 95%CI: 0.14–1.68) 密切相关，但与 SCD 无关 (logOR: 0.26, 95%CI: −1.09–1.6)。诊断准确性分析表明，对比增强是未来 ADT 和心源性死亡的敏感标志（93%，95%CI：85.8-96.7%；82.9%，95%CI：70.6-90.7%；分别），具有中等特异性（44 %，95%CI：27.2–62.6%；37.7%，95%CI：23.4–54.6%；分别）。

结论

LGE 是植入用于一级预防的除颤器的 NICM 患者 ADT 和心源性死亡的高度敏感预测因子。然而，由于中等特异性，需要得出具有足够预测值的临界值，并且可能需要采用多因素方法来提高对无法从 ICD 中受益的患者的区分。