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The prognostic value of late gadolinium enhancement in myocarditis and clinically suspected myocarditis: systematic review and meta-analysis

Abstract

Objective

To evaluate the prognostic value of late gadolinium enhancement (LGE) in myocarditis and clinically suspected myocarditis.

Methods

The study was registered in PROSPERO (CRD42019144976). A systematic search of PubMed, Ovid Medline, Embase, Web of Science and the Cochrane Central Register of Controlled Trials was completed. Major adverse cardiac event (MACE) was defined as the combination of all-cause mortality or cardiovascular death, resuscitated cardiac arrest, heart transplantation, appropriate implantable cardioverter-defibrillator shock, rehospitalisation following a cardiac event and recurrent acute myocarditis. Combined outcome was defined as the combination of all adverse events. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the prognostic value of LGE.

Results

Eight articles including 1319 patients (mean age, 38.8 ± 12.9 years) were included in the meta-analysis. The study showed that positive LGE was strongly associated with an increased risk of combined outcome (pooled OR, 5.85; 95% CI, 2.88 to 11.86; p < 0.001) and of MACE (pooled OR, 4.57; 95% CI, 2.18 to 9.59; p < 0.001). Additionally, in a subgroup analysis with mean ejection fraction (EF) point of 50%, the pooled ORs for the combined outcome were 6.46 for left ventricular EF (LVEF) > 50% and 7.90 for LVEF ≤ 50%, and the pooled ORs for MACE were 9.03 and 3.45, respectively. After 3 years of follow-up, the worse outcomes occurred mainly in patients with positive LGE.

Conclusion

Positive LGE is a powerful prognosticator of adverse outcome in myocarditis and clinically suspected myocarditis, irrespective of LVEF.

Key Points

• Forty-four percent to 100% of myocarditis patients have positive late gadolinium enhancement.

• Positive LGE was a powerful prognosticator of adverse outcome in myocarditis and clinically suspected myocarditis, irrespective of LVEF.

• LGE-CMR is important tool for risk stratification in myocarditis and clinically suspected myocarditis.

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Abbreviations

CI:

Confidence interval

CMR:

Cardiovascular magnetic resonance

DCM:

Dilated cardiomyopathy

ECMO:

Extracorporeal membrane oxygenation

EDVI:

End-diastolic volume index

EF:

Ejection fraction

EMB:

Endomyocardial biopsy

HCM:

Hypertrophic cardiomyopathy

HR:

Hazard ratio

I 2 :

Inconsistency index

ICD:

Implantable cardioverter-defibrillator

LGE:

Late gadolinium enhancement

LLC:

Lake Louise Criteria

LV:

Left ventricular

MACE:

Major adverse cardiac event

OR:

Odds ratios

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

RCT:

Randomised controlled trial

RV:

Right ventricular

SCD:

Sudden cardiac death

VAD:

Ventricular assist device

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Funding

This study has received funding by the National Natural Science Foundation of China (contract grant numbers: 81571638) and 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University (No: ZYJC18013).

Author information

Correspondence to Rui Zeng or Yucheng Chen.

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Guarantor

The scientific guarantor of this publication is Yucheng Chen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because only published data were used.

Ethical approval

Institutional Review Board approval was not required because only published data were used.

Study subjects or cohorts overlap

Studies with duplicate data was excluded from the meta-analysis.

Methodology

• Multicentre study

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Yang, F., Wang, J., Li, W. et al. The prognostic value of late gadolinium enhancement in myocarditis and clinically suspected myocarditis: systematic review and meta-analysis. Eur Radiol (2020). https://doi.org/10.1007/s00330-019-06643-5

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Keywords

  • Magnetic resonance imaging
  • Myocarditis
  • Prognosis
  • Fibrosis
  • Meta-analysis