PDF(Pubmed)
Abstract：
Cardiac involvement is the foremost determinant of the clinical progression of amyloidosis. The diagnostic role of cardiac magnetic resonance (CMR) imaging in cardiac amyloidosis has been established, but the prognostic role of various right and left CMR tissue characterization and functional parameters, including global longitudinal strain (GLS), late gadolinium enhancement (LGE), and parametric mapping, is yet to be delineated. We searched EMBASE, PubMed, and MEDLINE for studies analysing the prognostic use of CMR imaging in patients with light chain amyloidosis or transthyretin amyloidosis cardiac amyloidosis. The primary endpoint was all-cause mortality. A random effects model was used to calculate a pooled odds ratio using inverse-variance weighting. Nineteen studies with 2199 patients [66% males, median age 59.7 years, interquartile range (IQR) 58-67] were included. Median follow-up was 24 months (IQR 20-32), during which 40.8% of patients died. Both tissue characterization left heart parameters such as elevated extracellular volume [hazard ratio (HR) 3.95, 95% confidence interval (CI) 3.01-5.17], extension of left ventricular (LV) LGE (HR 2.69, 95% CI 2.07-3.49) elevated native T1 (HR 2.19, 95% CI 1.12-4.28), and functional parameters such as reduced LV GLS (HR 1.91, 95% CI 1.52-2.41) and reduced LV ejection fraction (EF; HR 1.20, 95% CI 1.17-1.23) were associated with increased all-cause mortality. Unlike the presence of right ventricular (RV) LGE (HR 3.40, 95% CI 0.51-22.54), parameters such as RV GLS (HR 2.08, 95% CI 1.6-2.69), RVEF (HR 1.13, 95% CI 1.05-1.22), and tricuspid annular systolic excursion (TAPSE) (HR 1.11, 95% CI 1.02-1.21) were also associated with mortality. In this large meta-analysis of patients with cardiac amyloidosis, CMR parameters assessing RV and LV function and tissue characterization were associated with an increased risk of mortality.
摘要：
心脏受累是淀粉样变性临床进展的首要决定因素。已经建立了心脏磁共振（CMR）成像在心脏淀粉样变性中的诊断作用，但是各种左右CMR组织表征和功能参数的预后作用，包括全球纵向应变(GLS)，晚期钆增强(LGE)，和参数映射，尚未划定。我们搜索了EMBASE,PubMed,和MEDLINE用于分析CMR成像在轻链淀粉样变性或转甲状腺素蛋白淀粉样变性心脏淀粉样变性患者中的预后应用。主要终点是全因死亡率。使用随机效应模型使用方差逆加权来计算合并赔率比。19项研究涉及2199名患者[66%为男性，中位年龄59.7岁，四分位距（IQR）58-67]包括在内。中位随访时间为24个月（IQR20-32），在此期间，40.8%的患者死亡。两种组织表征都留下心脏参数，例如细胞外体积升高[风险比（HR）3.95，95％置信区间（CI）3.01-5.17]，左心室（LV）LGE延伸（HR2.69，95%CI2.07-3.49）升高的自然T1（HR2.19，95%CI1.12-4.28），功能参数如LVGLS降低(HR1.91,95%CI1.52-2.41)和LV射血分数降低(EF;HR1.20,95%CI1.17-1.23)与全因死亡率增加相关.与右心室（RV）LGE的存在不同（HR3.40，95％CI0.51-22.54），参数，如RVGLS(HR2.08，95%CI1.6-2.69)，RVEF（HR1.13，95%CI1.05-1.22），三尖瓣环收缩期偏移(TAPSE)(HR1.11,95%CI1.02-1.21)也与死亡率相关.在这项对心脏淀粉样变性患者的大型荟萃分析中，评估RV和LV功能和组织特征的CMR参数与死亡风险增加相关。
