Prognostic Impact of Late Gadolinium Enhancement by CMR in Myocarditis: A Systematic Review and Meta-analysis

TY - JOUR

T1 - Prognostic Impact of Late Gadolinium Enhancement by CMR in Myocarditis: A Systematic Review and Meta-analysis

AU - Georgiopoulos, Georgios

AU - Figliozzi, Stefano

AU - Sanguineti, Francesca

AU - Aquaro, Giovanni

AU - di Bella, Gianluca

AU - Stamatelopoulos, Kimon

AU - Chiribiri, Amedeo

AU - Garot, Jerome

AU - Masci, Pier-Giorgio

AU - Ismail, Tevfik

PY - 2020/11/16

Y1 - 2020/11/16

N2 - Background: Patients with acute myocarditis (AM) are at increased risk of adverse cardiac events after the index episode. Late gadolinium enhancement (LGE) detected by cardiovascular magnetic resonance (CMR) in patients with AM plays an important diagnostic role but its prognostic significance remains unresolved. This systematic review and meta-analysis sought to assess the prognostic implications of CMR-derived LGE in patients with AM. Methods: Data search was conducted from inception through February 28, 2020, using the following Medical Subject Heading terms: Myocarditis, CMR, MRI, Magnetic Resonance. From 2,422 articles retrieved, we selected 11 studies reporting baseline CMR assessment and long-term clinical follow-up in AM patients. Hazard ratios (HR) and confidence intervals (CIs) for a combined clinical endpoint were recorded for LGE presence, extent (>2 segments or >10% of left ventricular [LV] mass or >17g) and location (anteroseptal [AS] vs. non-AS). A combined endpoint comprised all-cause mortality, cardiac mortality, and MACE. Hartung and Knapp (HK) correction improved robustness of the results. Pre-specified sensitivity analyses explored potential sources of heterogeneity. The meta-analysis was conducted according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Results: LGE presence (pooled-HR=3.28, 95% CIs 1.69-6.39, P<0.001; 95% CIs 1.33-8.11 after HK correction) and AS LGE (pooled-HR=2.58, 95% CIs 1.87-3.55, P<0.001; 95% CIs 1.64-4.06 after HK correction) were associated with an increased risk of the combined endpoint. Extensive LGE was associated with worse outcomes (pooled-HR=1.96, 95% CIs 1.08-3.56, P=0.027) but this association was not confirmed after HK correction (95% CIs =0.843-4.57). Conclusion: LGE presence and anteroseptal location at baseline CMR are important independent prognostic markers that herald an increased risk of adverse cardiac outcomes in patients with AM. Registration: https://www.crd.york.ac.uk/PROSPERO/ Unique identifier: CRD42019146619.

AB - Background: Patients with acute myocarditis (AM) are at increased risk of adverse cardiac events after the index episode. Late gadolinium enhancement (LGE) detected by cardiovascular magnetic resonance (CMR) in patients with AM plays an important diagnostic role but its prognostic significance remains unresolved. This systematic review and meta-analysis sought to assess the prognostic implications of CMR-derived LGE in patients with AM. Methods: Data search was conducted from inception through February 28, 2020, using the following Medical Subject Heading terms: Myocarditis, CMR, MRI, Magnetic Resonance. From 2,422 articles retrieved, we selected 11 studies reporting baseline CMR assessment and long-term clinical follow-up in AM patients. Hazard ratios (HR) and confidence intervals (CIs) for a combined clinical endpoint were recorded for LGE presence, extent (>2 segments or >10% of left ventricular [LV] mass or >17g) and location (anteroseptal [AS] vs. non-AS). A combined endpoint comprised all-cause mortality, cardiac mortality, and MACE. Hartung and Knapp (HK) correction improved robustness of the results. Pre-specified sensitivity analyses explored potential sources of heterogeneity. The meta-analysis was conducted according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Results: LGE presence (pooled-HR=3.28, 95% CIs 1.69-6.39, P<0.001; 95% CIs 1.33-8.11 after HK correction) and AS LGE (pooled-HR=2.58, 95% CIs 1.87-3.55, P<0.001; 95% CIs 1.64-4.06 after HK correction) were associated with an increased risk of the combined endpoint. Extensive LGE was associated with worse outcomes (pooled-HR=1.96, 95% CIs 1.08-3.56, P=0.027) but this association was not confirmed after HK correction (95% CIs =0.843-4.57). Conclusion: LGE presence and anteroseptal location at baseline CMR are important independent prognostic markers that herald an increased risk of adverse cardiac outcomes in patients with AM. Registration: https://www.crd.york.ac.uk/PROSPERO/ Unique identifier: CRD42019146619.

M3 - Article

SN - 1941-9651

JO - Circulation-Cardiovascular imaging

JF - Circulation-Cardiovascular imaging

ER -