Background:In ischemic cardiomyopathy, cardiac magnetic resonance assessment of the peri-infarct zone, a potential substrate for arrhythmogenesis, may serve as a novel prognosticator and guide the optimal use of implantable cardioverter-defibrillators. We undertook a systematic review and meta-analysis assessing the prognostic value of the peri-infarct zone on late gadolinium enhancement cardiac magnetic resonance in ischemic cardiomyopathy.Methods:We searched MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Medical Literature Analysis and Retrieval System Online), and CENTRAL (Medical Literature Analysis and Retrieval System Online) from inception to January 2019 for prognostic studies relating peri-infarct size with clinical outcomes in ischemic cardiomyopathy. Two authors independently performed study selection and data extraction. Pooled effect estimates were calculated with random effects models, risk of bias and strength of evidence were assessed by the Quality in Prognostic Studies tool and Grading of Recommendations Assessment, Development, and Education, respectively.Results:Twenty studies were eligible, representing 14 cohort studies (n=1518) with mean follow-up of 3.6 years and 6 cross-sectional studies (n=189). The extent of the peri-infarct zone was significantly predictive of all-cause mortality (3 studies; n=539; hazard ratio, 1.34/10 g [95% CI, 1.13–1.59]; I²=0%; high-quality evidence), appropriate implantable cardioverter-defibrillator therapy (5 studies; n=361; hazard ratio, 1.31/10 g [95% CI, 1.17–1.47]; I²=0%; high-quality evidence), and inducibility of ventricular tachycardia on electrophysiological study (5 studies; n=167; OR, 2.63/g [95% CI, 1.39–4.96]; I²=14%; low-quality evidence). After adjusting for age and left ventricular ejection fraction, the peri-infarct zone, as a percentage of total infarct size, remained an independent predictor of all-cause mortality (2 studies; n=445; hazard ratio, 1.29/10% [95% CI, 1.15–1.44]; I²=0%; high-quality evidence).Conclusions:There is limited but consistent evidence that quantification of the peri-infarct zone predicts long-term mortality and appropriate implantable cardioverter-defibrillator therapy in ischemic cardiomyopathy. Future studies should confirm whether late gadolinium enhancement-cardiac magnetic resonance assessment may improve implantable cardioverter-defibrillator treatment decisions.Clinical Trial Registration:URL: https://www.crd.york.ac.uk/prospero/. Unique identifier: CRD42017077337.

中文翻译：

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通过心肌磁共振对梗死周围梗死进行定量，以预测缺血性心肌病的预后：系统的预后评价和荟萃分析。

背景：在缺血性心肌病中，对梗死周围区域（可能是心律失常的潜在底物）进行心脏磁共振评估，可以作为一种新的预后指标，并指导植入式心脏复律除颤器的最佳使用。我们进行了系统的回顾和荟萃分析，评估了梗死周围区对缺血性心肌病中晚期g增强心脏磁共振的预后价值。方法：我们搜索了MEDLINE（医学文献分析和在线检索系统），EMBASE（医学文献分析）从开始到2019年1月，以及CENTRAL（医学文献分析和检索系统在线），用于将梗死周围面积与缺血性心肌病的临床结局相关的预后研究。两位作者独立进行研究选择和数据提取。采用随机效应模型计算合并的效应估计值，分别通过预后研究质量工具和推荐评估，发展和教育等级对偏倚风险和证据强度进行评估。结果：有20项研究符合条件，代表了14项队列研究（n = 1518），平均随访时间为3.6年，进行了6项横断面研究（n = 189）。梗塞周围区域的范围可显着预测所有原因的死亡率（3项研究； n = 539；危险比：1.34 / 10 g [95％CI，1.13-1.59]；结果：二十项研究符合条件，代表了14项队列研究（n = 1518），平均随访3。6年，进行了6项横断面研究（n = 189）。梗塞周围区域的范围可显着预测所有原因的死亡率（3项研究； n = 539；危险比：1.34 / 10 g [95％CI，1.13-1.59]；结果：二十项研究符合条件，代表了14项队列研究（n = 1518），平均随访3。6年，进行了6项横断面研究（n = 189）。梗塞周围区域的范围可显着预测所有原因的死亡率（3项研究； n = 539；危险比：1.34 / 10 g [95％CI，1.13-1.59]；我² = 0％; 高质量证据），适当的植入式心脏复律除颤器疗法（5个研究； n = 361；危险比，1.31 / 10 g [95％CI，1.17-1.47]；I ² = 0％；高质量证据），以及电生理研究对室性心动过速的诱导性（5项研究； n = 167； OR，2.63 / g [95％CI，1.39–4.96]；I ² = 14％；低质量证据）。调整年龄和左心室射血分数后，梗塞周围区占梗塞总面积的百分比仍是全因死亡率的独立预测因子（2项研究； n = 445；危险比为1.2 / 10％[95] ％CI，1.15-1.44]；I ²= 0％；结论：结论有限但始终如一的证据表明，对梗死周围区域的量化可预测缺血性心肌病的长期死亡率和适当的植入式心脏复律除颤器治疗。未来的研究应证实late增强心脏磁共振评估是否可以改善植入式心脏复律除颤器的治疗决策。临床试验注册：URL：https：//www.crd.york.ac.uk/prospero/。唯一标识符：CRD42017077337。