心脏MR延迟钆强化评估心肌淀粉样变性患者预后:Meta分析北大核心CSCD

目的采用Meta分析方法评价心脏MR(CMR)延迟钆强化(LGE)评估心肌淀粉样变(CA)患者预后的价值。方法检索PubMed、EMbase、Cochrane Library、中国生物医学文献数据库、中国知网及万方医学网自建库至2020年10月以CMR-LGE评价CA患者死亡风险的队列研究,依照纳入及排除标准筛选文献;合并纳入文献中的死亡风险比(HR),评价LGE阳性、LGE类型或位置、CA类型与CA患者死亡风险的关系,以STATA 15.0软件行Meta分析。结果共纳入14篇文献,均为英文文献,包括1490例患者,其中666例发生死亡事件。合并分析结果显示LGE阳性患者死亡风险增大,HR为1.4695%CI(1.06,2.02),P<0.05];透壁性HR=2.36,95%CI(1.79,3.12),P<0.05]及心内膜下LGE阳性HR=3.83,95%CI(2.12,6.91),P<0.05]患者死亡风险增高;左心室HR=2.82,95%CI(1.33,5.98),P<0.05]及右心室LGE阳性HR=1.94,95%CI(1.12,3.35),P<0.05]患者死亡风险不同程度升高;轻链型淀粉样变性患者LGE阳性死亡风险增大,HR为1.9495%CI(1.53,2.46),P<0.05]。结论CMR-LGE阳性与CA患者死亡风险增加密切相关,可作为预测CA患者预后的独立因素。

Cardiac MR late gadolinium enhancement in evaluation on prognosis of patients with cardiac amyloidosis: Meta-analysis

Objective To observe the value of cardiac MR (CMR) late gadolinium enhancement (LGE) in evaluation on prognosis of patients with cardiac amyloidosis (CA) with meta-analysis.Methods The cohort studies using CMR-LGE to evaluate the risk of death in patients with CA were searched in the PubMed, EMbase, Cochrane Library, CBMdisc, CNKI and Wanfang Med Online from the time of database establishment to October 2020, and then were screened according to inclusion and exclusion criteria. The relationships of LGE positivity, LGE type or location, CA type and the risk of death in CA patients were evaluated using hazard ratio (HR) of death in the included literature. Meta-analysis was performed using STATA 15.0 software.Results Data extracted from 14 studies all in English including 1 490 patients with 666 cases of death were reviewed. Totally, the presence of LGE had increased risk of death (HR=1.46, 95%CI, P < 0.05), while transmural LGE (HR=2.36, 95%CI, P < 0.05) and subendocardial LGE (HR=3.83, 95%CI, P < 0.05) showed higher risk of death. Myocardial LGE occurred in left ventricular (HR=2.82, 95%CI, P < 0.05) and right ventricular LGE (HR=1.94, 95%CI, P < 0.05) were related to increasing risk of death with different degrees, and the presence of LGE was associated with higher mortality in light-chain amyloidosis patients (HR=1.94, 95%CI, P < 0.05).Conclusion The presence of CMR-LGE was associated with higher mortality in CA patients, which could be taken as an independent prognostic factor in patients with CA.