| Abstrakt: |
Key Points: Question: Are cardiac magnetic resonance imaging–derived measurements associated with adverse outcomes in nonischemic dilated cardiomyopathy (NIDCM)? Findings: In this meta-analysis of 103 studies comprising 29 687 patients with NIDCM, late gadolinium enhancement (LGE) presence and extent were consistently associated with arrhythmic, nonarrhythmic, and mortality end points, whereas left ventricular ejection fraction (LVEF) was not significantly associated with mortality and arrhythmia. Higher native T1 relaxation times were associated with arrhythmic end points and major adverse cardiac events. Due to insufficient data, a pooled analysis could not be conducted for the measurements of native T1 relaxation times, extracellular volume fraction, and global longitudinal strain concerning mortality end points. Meaning: The presence and extent of LGE were associated with adverse clinical outcomes, whereas LVEF was not associated with mortality and arrhythmic end points in NIDCM. Importance: Accurate risk stratification of nonischemic dilated cardiomyopathy (NIDCM) remains challenging. Objective: To evaluate the association of cardiac magnetic resonance (CMR) imaging–derived measurements with clinical outcomes in NIDCM. Data Sources: MEDLINE, Embase, Cochrane Library, and Web of Science Core Collection databases were systematically searched for articles from January 2005 to April 2023. Study Selection: Prospective and retrospective nonrandomized diagnostic studies reporting on the association between CMR imaging–derived measurements and adverse clinical outcomes in NIDCM were deemed eligible. Data Extraction and Synthesis: Prespecified items related to patient population, CMR imaging measurements, and clinical outcomes were extracted at the study level by 2 independent reviewers. Random-effects models were fitted using restricted maximum likelihood estimation and the method of Hartung, Knapp, Sidik, and Jonkman. Main Outcomes and Measures: All-cause mortality, cardiovascular mortality, arrhythmic events, heart failure events, and major adverse cardiac events (MACE). Results: A total of 103 studies including 29 687 patients with NIDCM were analyzed. Late gadolinium enhancement (LGE) presence and extent (per 1%) were associated with higher all-cause mortality (hazard ratio [HR], 1.81 [95% CI, 1.60-2.04]; P <.001 and HR, 1.07 [95% CI, 1.02-1.12]; P =.02, respectively), cardiovascular mortality (HR, 2.43 [95% CI, 2.13-2.78]; P <.001 and HR, 1.15 [95% CI, 1.07-1.24]; P =.01), arrhythmic events (HR, 2.69 [95% CI, 2.20-3.30]; P <.001 and HR, 1.07 [95% CI, 1.03-1.12]; P =.004) and heart failure events (HR, 1.98 [95% CI, 1.73-2.27]; P <.001 and HR, 1.06 [95% CI, 1.01-1.10]; P =.02). Left ventricular ejection fraction (LVEF) (per 1%) was not associated with all-cause mortality (HR, 0.99 [95% CI, 0.97-1.02]; P =.47), cardiovascular mortality (HR, 0.97 [95% CI, 0.94-1.00]; P =.05), or arrhythmic outcomes (HR, 0.99 [95% CI, 0.97-1.01]; P =.34). Lower risks for heart failure events (HR, 0.97 [95% CI, 0.95-0.98]; P =.002) and MACE (HR, 0.98 [95% CI, 0.96-0.99]; P <.001) were observed with higher LVEF. Higher native T1 relaxation times (per 10 ms) were associated with arrhythmic events (HR, 1.07 [95% CI, 1.01-1.14]; P =.04) and MACE (HR, 1.06 [95% CI, 1.01-1.11]; P =.03). Global longitudinal strain (GLS) (per 1%) was not associated with heart failure events (HR, 1.06 [95% CI, 0.95-1.18]; P =.15) or MACE (HR, 1.03 [95% CI, 0.94-1.14]; P =.43). Limited data precluded definitive analysis for native T1 relaxation times, GLS, and extracellular volume fraction (ECV) with respect to mortality outcomes. Conclusion: The presence and extent of LGE were associated with various adverse clinical outcomes, whereas LVEF was not significantly associated with mortality and arrhythmic end points in NIDCM. Risk stratification using native T1 relaxation times, extracellular volume fraction, and global longitudinal strain requires further evaluation. This meta-analysis investigates the association of various cardiac MRI–derived measurements with adverse clinical outcomes in patients with nonischemic dilated cardiomyopathy for the purpose of risk stratification. [ABSTRACT FROM AUTHOR] |
