Objective To evaluate the predictive value of late gadolinium enhancement-cardiac magnetic resonance imaging(LGE-CMR)on cardiovascular events in patients with chronic heart failure. Methods From creating database to January 2018,databases such as PubMed,EMBase,The Cochrane Library,CNKI,Wanfang Data Knowledge Service Platform and VIP were searched by computer to collect related studies about prognosis in chronic heart failure patients undergoing LGE-CMR examination. According to LGE-CMR examination results,patients were divided into LGE(+)group(with myocardial late enhancement)and LGE(-)group(without myocardial late enhancement),incidence of cardiovascular events such as cardiac death,ventricular arrhythmia and heart failure-induced re-hospitalization rate were compared between the two group;RevMan 5.3 software was used to carry out the Meta-analysis. Results A total of 10 literatures were involved eventually,including 1 509 patients,thereinto 414 were ischemic heart disease,the other 1 095 were non ischemic heart disease. Meta-analysis results showed that,cardiac mortality〔OR=4.26,95%CI(2.59,7.01)〕and incidence of ventricular arrhythmia〔OR=5.61,95%CI(3.91,8.04)〕in LGE(+)group were statistically significantly higher than those in LGE(-)group(P＜0.05);subgroup analysis results showed that,incidence of ventricular arrhythmia in patients with ischemic heart disease,with non ischemic heart disease,with implantation of ICD in LGE(+)group was statistically significantly higher than that in patients with ischemic heart disease,with non ischemic heart disease,with implantation of ICD in LGE(-)group(P＜0.05). No statistically significant differences of heart failure-induced re-hospitalization rate was found between the two groups〔OR=1.71,95%CI(0.69,4.28),P=0.25〕. Sensitivity analysis results showed that,estimation value of the 10 involved literatures was belong to confidence interval of the total effect value,verified that the Meta-analysis results are relatively stable;Begg's test results showed that,there was no publication bias in the literatures that reported cardiac mortality,incidence of ventricular arrhythmia and heart failure-induced re-hospitalization rate(P＞0.05). Conclusion Based on existing literatures,risk of cardiac death and ventricular arrhythmias in chronic heart failure patients with LGE-CMR showed myocardial late enhancement is relatively high,but LGE-CMR has limit predictive value on heart failure-induced re-hospitalization.%目的 评价延迟钆增强-心脏磁共振成像(LGE-CMR)对慢性心力衰竭患者心血管事件的预测价值.方法 计算机检索PubMed、EMBase、The Cochrane Library、中国知网(CNKI)、万方数据知识服务平台、维普网(VIP)等数据库,检索有关行LGE-CMR检查的慢性心力衰竭患者预后的研究,检索时间为建库至2018年1月.根据LGE-CMR检查结果是否存在心肌延迟强化分为LGE(+)组与LGE(-)组,比较两组患者心源性死亡、室性心律失常、心力衰竭再入院等心血管事件发生率;采用RevMan 5.3软件进行Meta分析.结果 最终纳入10篇文献,包括1 509例患者,其中缺血性心脏病患者414例、非缺血性心脏病患者1 095例.Meta分析结果显示,LGE(+)组患者心源性死亡率〔OR=4.26,95%CI(2.59,7.01)〕和室性心律失常发生率〔OR=5.61,95%CI(3.91,8.04)〕高于LGE(-)组(P＜0.05);亚组分析结果显示,LGE(+)组缺血性心脏病患者、非缺血性心脏病患者、植入埋藏式心律转复除颤器(ICD)患者室性心律失常发生率分别高于LGE(-)组缺血性心脏病患者、非缺血性心脏病患者、植入ICD患者(P＜0.05).两组患者心力衰竭再入院率比较,差异无统计学意义〔OR=1.71,95%CI(0.69,4.28),P=0.25〕.敏感性分析结果显示,10篇文献的估计值均在总效应值可信区间内,提示结果较为稳定;Begg's test检验结果显示,报道心源性死亡率、室性心律失常发生率及心力衰竭再入院率的文献间无发表偏倚(P＞0.05).结论 基于现有文献, LGE-CMR结果显示存在心肌延迟强化的慢性心力衰竭患者心源性死亡、室性心律失常发生率较高,但对心力衰竭再入院率预测价值有限.
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