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Left ventricular midwall fibrosis as a predictor of sudden cardiac death in non-ischaemic dilated cardiomyopathy: a meta-analysis.

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机构： [1]Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan, 610041, China. [2]Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK. [3]Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China. [4]Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, PA, USA. [5]Department of Cardiology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China.

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关键词： Late gadolinium enhancement (LGE) Midwall Dilated cardiomyopathy Meta-analysis

摘要：

Identification of patients with non-ischaemic dilated cardiomyopathy (NICM) who are at risk of sudden cardiac death (SCD) and could benefit from an implantable cardioverter defibrillator (ICD) is challenging. The study aims to systematically assess the prognostic value of left ventricular (LV) midwall late gadolinium enhancement (LGE) pattern in patients with NICM and further explore its value on predicting SCD events. The study was prospectively registered in PROPSERO (CRD42019138468). We systematically searched PubMed, Ovid Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov to identify studies that evaluated the association between LV midwall LGE and clinical outcomes (all-cause mortality, cardiovascular mortality, and SCD or aborted SCD endpoint) in NICM patients. A meta-analysis was performed to determine pooled odds ratio (OR) for these adverse events. Seven studies including 1827 NICM patients over a mean follow-up duration of 36.1 ± 19.3 months were included. The presence of LV midwall LGE pattern was observed in 562 (30.8%) patients. The pooled OR was 3.37 [95% confidence intervals (CIs): 1.35-8.42] for all-cause mortality, 5.56 (95% CI: 1.23-25.22) for cardiovascular mortality, and 2.25 (95% CI: 1.16-3.16) for SCD or aborted SCD. In a subgroup analysis with mean ejection fraction cut-off point of 35%, the pooled OR for SCD or aborted SCD was 2.06 (95% CI: 1.32-3.22) for LV ejection fraction (LVEF) > 35% and 2.49 (95% CI: 1.48-4.20) for LVEF ≤ 35%. In addition, our study indicated that LV midwall LGE showed an excellent negative predictive value in identifying high-risk NICM patients and that the number needed to treat with ICD implantation in NICM patients with midwall LGE is 7. The presence of LV midwall on LGE is a significant prognosticator of adverse events in NICM patients. Additionally, patients with LV midwall LGE may be considered for ICD therapy irrespective of LVEF. © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

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出版当年[2020]版：

大类 | 2 区医学

小类 | 3 区心脏和心血管系统

最新[2023]版：

大类 | 2 区医学

小类 | 3 区心脏和心血管系统

第一作者：

第一作者机构： [1]Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan, 610041, China. [2]Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.

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通讯作者：

通讯机构： [1]Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan, 610041, China. [5]Department of Cardiology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China. [*1]Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, China.

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Left ventricular midwall fibrosis as a predictor of sudden cardiac death in non-ischaemic dilated cardiomyopathy: a meta-analysis.

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