Abstract：
OBJECTIVE: To perform a systematic review and meta-analysis of studies investigating the diagnostic value of cardiac magnetic resonance (CMR) features for arrhythmic risk stratification in mitral valve prolapse (MVP) patients.
METHODS: EMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting MVP patients who underwent CMR with assessment of: left ventricular (LV) size and function, mitral regurgitation (MR), prolapse distance, mitral annular disjunction (MAD), curling, late gadolinium enhancement (LGE), and T1 mapping, and reported the association with arrhythmia. The primary endpoint was complex ventricular arrhythmias (co-VAs) as defined by any non-sustained ventricular tachycardia, sustained ventricular tachycardia, ventricular fibrillation, or aborted sudden cardiac death. Meta-analysis was performed when at least three studies investigated a CMR feature. PROSPERO registration number: CRD42023374185.
RESULTS: The meta-analysis included 11 studies with 1278 patients. MR severity, leaflet length/thickness, curling, MAD distance, and mapping techniques were not meta-analyzed as reported in < 3 studies. LV end-diastolic volume index, LV ejection fraction, and prolapse distance showed small non-significant effect sizes. LGE showed a strong and significant association with co-VA with a LogORs of 2.12 (95% confidence interval (CI): [1.00, 3.23]), for MAD the log odds-ratio was 0.95 (95% CI: [0.30, 1.60]). The predictive accuracy of LGE was substantial, with a hierarchical summary ROC AUC of 0.83 (95% CI: [0.69, 0.91]) and sensitivity and specificity rates of 0.70 (95% CI: [0.41, 0.89]) and 0.80 (95% CI: [0.67, 0.89]), respectively.
CONCLUSIONS: Our study highlights the role of LGE as the key CMR feature for arrhythmia risk stratification in MVP patients. MAD might complement arrhythmic risk stratification.
CONCLUSIONS: LGE is a key factor for arrhythmogenic risk in MVP patients, with additional contribution from MAD. Combining MRI findings with clinical characteristics is critical for evaluating and accurately stratifying arrhythmogenic risk in MVP patients.
CONCLUSIONS: MVP affects 2-3% of the population, with some facing increased risk for arrhythmia. LGE can assess arrhythmia risk, and MAD may further stratify patients. CMR is critical for MVP arrhythmia risk stratification, making it essential in a comprehensive evaluation.
METHODS: EMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting MVP patients who underwent CMR with assessment of: left ventricular (LV) size and function, mitral regurgitation (MR), prolapse distance, mitral annular disjunction (MAD), curling, late gadolinium enhancement (LGE), and T1 mapping, and reported the association with arrhythmia. The primary endpoint was complex ventricular arrhythmias (co-VAs) as defined by any non-sustained ventricular tachycardia, sustained ventricular tachycardia, ventricular fibrillation, or aborted sudden cardiac death. Meta-analysis was performed when at least three studies investigated a CMR feature. PROSPERO registration number: CRD42023374185.
RESULTS: The meta-analysis included 11 studies with 1278 patients. MR severity, leaflet length/thickness, curling, MAD distance, and mapping techniques were not meta-analyzed as reported in < 3 studies. LV end-diastolic volume index, LV ejection fraction, and prolapse distance showed small non-significant effect sizes. LGE showed a strong and significant association with co-VA with a LogORs of 2.12 (95% confidence interval (CI): [1.00, 3.23]), for MAD the log odds-ratio was 0.95 (95% CI: [0.30, 1.60]). The predictive accuracy of LGE was substantial, with a hierarchical summary ROC AUC of 0.83 (95% CI: [0.69, 0.91]) and sensitivity and specificity rates of 0.70 (95% CI: [0.41, 0.89]) and 0.80 (95% CI: [0.67, 0.89]), respectively.
CONCLUSIONS: Our study highlights the role of LGE as the key CMR feature for arrhythmia risk stratification in MVP patients. MAD might complement arrhythmic risk stratification.
CONCLUSIONS: LGE is a key factor for arrhythmogenic risk in MVP patients, with additional contribution from MAD. Combining MRI findings with clinical characteristics is critical for evaluating and accurately stratifying arrhythmogenic risk in MVP patients.
CONCLUSIONS: MVP affects 2-3% of the population, with some facing increased risk for arrhythmia. LGE can assess arrhythmia risk, and MAD may further stratify patients. CMR is critical for MVP arrhythmia risk stratification, making it essential in a comprehensive evaluation.
摘要：
目的：对研究心脏磁共振（CMR）特征对二尖瓣脱垂（MVP）患者心律失常危险分层的诊断价值进行系统评价和荟萃分析。
方法：EMBASE，PubMed/MEDLINE,和CENTRAL被搜索的研究报告MVP患者接受CMR评估：左心室（LV）大小和功能，二尖瓣反流(MR),脱垂距离,二尖瓣环分离(MAD),卷曲，晚期钆增强(LGE)，和T1映射，并报告了与心律失常的关联。主要终点是由任何非持续性室性心动过速定义的复杂性室性心律失常（co-VAs）。持续性室性心动过速,心室纤颤,或者心脏性猝死流产.当至少三项研究调查了CMR特征时，进行了荟萃分析。PROSPERO注册号：CRD42023374185。
结果：荟萃分析包括11项研究，共1278例患者。MR严重程度,小叶长度/厚度，卷曲，MAD距离,和映射技术未进行荟萃分析，如<3项研究中报道的。左心室舒张末期容积指数,左心室射血分数,脱垂距离显示出小的非显著效应大小。LGE与co-VA有很强的显著关联，对数为2.12(95%置信区间(CI)：[1.00,3.23])，对于MAD，对数比值比为0.95（95%CI：[0.30，1.60]）。LGE的预测准确性很高，分层汇总ROCAUC为0.83（95％CI：[0.69，0.91]），敏感性和特异性为0.70（95％CI：[0.41，0.89]）和0.80（95％CI：[0.67，0.89]），分别。
结论：我们的研究强调了LGE作为MVP患者心律失常危险分层的关键CMR特征的作用。MAD可能补充心律失常危险分层。
结论：LGE是MVP患者发生心律失常风险的关键因素，MAD的额外贡献。将MRI表现与临床特征相结合对于评估和准确分层MVP患者的心律失常风险至关重要。
结论：MVP影响2-3％的人口，有些人面临心律失常的风险增加。LGE可以评估心律失常风险，MAD可以进一步对患者进行分层。CMR对于MVP心律失常风险分层至关重要，使其在全面评估中至关重要。
方法：EMBASE，PubMed/MEDLINE,和CENTRAL被搜索的研究报告MVP患者接受CMR评估：左心室（LV）大小和功能，二尖瓣反流(MR),脱垂距离,二尖瓣环分离(MAD),卷曲，晚期钆增强(LGE)，和T1映射，并报告了与心律失常的关联。主要终点是由任何非持续性室性心动过速定义的复杂性室性心律失常（co-VAs）。持续性室性心动过速,心室纤颤,或者心脏性猝死流产.当至少三项研究调查了CMR特征时，进行了荟萃分析。PROSPERO注册号：CRD42023374185。
结果：荟萃分析包括11项研究，共1278例患者。MR严重程度,小叶长度/厚度，卷曲，MAD距离,和映射技术未进行荟萃分析，如<3项研究中报道的。左心室舒张末期容积指数,左心室射血分数,脱垂距离显示出小的非显著效应大小。LGE与co-VA有很强的显著关联，对数为2.12(95%置信区间(CI)：[1.00,3.23])，对于MAD，对数比值比为0.95（95%CI：[0.30，1.60]）。LGE的预测准确性很高，分层汇总ROCAUC为0.83（95％CI：[0.69，0.91]），敏感性和特异性为0.70（95％CI：[0.41，0.89]）和0.80（95％CI：[0.67，0.89]），分别。
结论：我们的研究强调了LGE作为MVP患者心律失常危险分层的关键CMR特征的作用。MAD可能补充心律失常危险分层。
结论：LGE是MVP患者发生心律失常风险的关键因素，MAD的额外贡献。将MRI表现与临床特征相结合对于评估和准确分层MVP患者的心律失常风险至关重要。
结论：MVP影响2-3％的人口，有些人面临心律失常的风险增加。LGE可以评估心律失常风险，MAD可以进一步对患者进行分层。CMR对于MVP心律失常风险分层至关重要，使其在全面评估中至关重要。
