Background

The utility of an electrophysiologic study (EPS) in the risk stratification of cardiac sarcoidosis (CS) patients is not clear. We conducted a systemic review and meta-analysis to evaluate the utility of EPS in the risk stratification of CS patients.

Methods

We searched PubMed, Embase, and Scopus databases from their inception to 12/4/2020 with search terms “Cardiac sarcoidosis” And “Electrophysiological studies OR ablation”. The first and second authors reviewed all the studies. We extracted the data of positive and negative EPS, and outcomes defined as ventricular arrhythmias, implantable cardioverter defibrillator therapy, death, left ventricular assist device placement, or heart transplantation. Risk of bias assessment was done by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Subgroup analysis of patients with left ventricular ejection fraction (LVEF) >35%, and probable CS, no prior ventricular tachycardia (VT) and LVEF >35% were performed.

Results

We found 544 articles after removing duplicates. A total of 52 full articles were reviewed, and eight studies were included in the meta-analysis. The pooled sensitivity and specificity (95% confidence interval) of EPS in predicting clinical outcomes were 0.70 (0.51–0.85) and 0.93 (0.85–0.97), respectively. Subgroup analysis of patients with LVEF >35% resulted in pooled sensitivity of 0.63 (0.29–0.88) and pooled specificity of 0.97 (0.92–0.99), and subgroup analysis of patients with probable CS, no prior VT, and LVEF >35% resulted in pooled sensitivity of 0.71 (0.33–0.93) and pooled specificity of 0.96 (0.88–0.99) in predicting adverse clinical outcomes.

Conclusions

EPS is an effective risk stratification tool in patients with CS across all subgroups with high sensitivity and specificity.

中文翻译：

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电生理学研究在心脏结节病患者风险分层中的作用：荟萃分析和系统评价

背景

电生理研究 (EPS) 在心脏结节病 (CS) 患者风险分层中的效用尚不清楚。我们进行了系统回顾和荟萃分析，以评估 EPS 在 CS 患者风险分层中的效用。

方法

我们使用搜索词“心脏结节病”和“电生理学研究或消融”搜索了 PubMed、Embase 和 Scopus 数据库从其成立到 2020 年 12 月 4 日。第一作者和第二作者回顾了所有研究。我们提取了阳性和阴性 EPS 的数据，以及定义为室性心律失常、植入式心脏复律除颤器治疗、死亡、左心室辅助装置放置或心脏移植的结果。偏倚风险评估由诊断准确性研究的质量评估-2 工具完成。对左心室射血分数 (LVEF) >35%、可能发生 CS、既往无室性心动过速 (VT) 和 LVEF >35% 的患者进行亚组分析。

结果

删除重复后，我们找到了 544 篇文章。共审查了 52 篇完整的文章，八项研究被纳入荟萃分析。EPS 在预测临床结果方面的综合敏感性和特异性（95% 置信区间）分别为 0.70（0.51-0.85）和 0.93（0.85-0.97）。对 LVEF >35% 的患者进行亚组分析，得出的汇总敏感性为 0.63 (0.29–0.88)，汇总特异性为 0.97 (0.92–0.99)，对可能有 CS、无既往 VT 和 LVEF >35% 的患者进行亚组分析在预测不良临床结果方面的综合敏感性为 0.71 (0.33-0.93)，综合特异性为 0.96 (0.88-0.99)。

结论

EPS是所有亚组CS患者的有效风险分层工具，具有高敏感性和特异性。