心血管磁共振在急性心肌炎中的预后价值：对晚期钆增强的系统文献综述与荟萃分析及参数映射的叙述性文献综述。
完整摘要 · 中文译文
背景与目的：关于参数映射和晚期钆增强（LGE）在急性心肌炎（AM）患者中预后价值的数据有限。本荟萃分析旨在探讨通过心血管磁共振（CMR）评估的LGE在AM患者中的预后价值，包括更近期的证据。此外，对CMR参数映射的预后价值进行了叙述性综述。 材料与方法：系统检索在PubMed和Scopus数据库中进行，检索时间范围分别为从建库至2026年1月17日（PubMed）和2026年1月20日（Scopus）。通过检索共发现1296条记录。最终，16项研究被纳入本系统综述。13项研究被纳入关于LGE与AM临床结局之间关联的荟萃分析。复合终点定义为MACE和/或以下终点之一：全因死亡、需要住院的心力衰竭失代偿、心脏移植和复发性AM。MACE定义为心血管死亡（包括猝死）、持续性室性心动过速、心室颤动、需要起搏器的完全性房室传导阻滞和心源性休克的复合终点。5项研究被综述以评估参数映射参数的预后价值。经过初步计算，发现使用比仅MACE更广泛复合终点的研究引入了 substantial 异质性。因此，我们额外进行了仅纳入8项以MACE为终点研究的分析。 结果：预先 LGE的存在与复合终点发生概率升高相关。未调整的合并OR显示，LGE的存在与复合终点发生概率升高之间存在显著关系（ORLGE(+) vs. LGE(-)[95% CI] = 3.02 [1.40, 6.51]，p < 0.001），异质性较高（I2 = 81.98%，p < 0.0001）。在定性层面上，MACE研究亚组中获得的结果保持一致（ORLGE(+) vs. LGE(-)[95% CI] = 2.88 [2.01, 4.13]，p < 0.0001）。未检测到明确的发表偏倚证据；然而，检测小样本研究效应的效能有限，结果应谨慎解读。参数映射参数的预后价值未进行荟萃分析，且由于相应数据不足，以叙述性方式进行了综述。关于原生T1、T2和细胞外容积（ECV）预后价值的数据存在争议且有限。 结论：基于这些发现，LGE的存在似乎与AM患者的不良预后相关。然而，由于研究间存在显著异质性且效应估计未经调整，这些发现应谨慎解读。关于CMR衍生参数映射预后价值的证据仍然有限。需要大规模、前瞻性、设计良好的研究来确定参数映射在LGE之外对AM患者风险分层和结局预测的增量预后价值。
完整摘要 · 英文原文
BACKGROUND AND AIMS: Limited data exist on the prognostic value of parametric mapping and late gadolinium enhancement (LGE) in patients with acute myocarditis (AM). This meta-analysis aimed to investigate the prognostic value of LGE as assessed by using cardiovascular magnetic resonance (CMR) in patients with AM, including more recent evidence. Additionally, the prognostic value of CMR parametric mapping was narratively reviewed. MATERIALS AND METHODS: The systematic search was conducted in the PubMed and Scopus databases from inception to January 17, 2026 (PubMed) and January 20th 2026 (Scopus). 1296 records were found through the search. Finally, sixteen studies were included in this systematic review. Thirteen studies were included in the meta-analysis on association between LGE and clinical outcomes in AM. The composite endpoint was defined as MACE and/or one of the following endpoints: all-cause death, heart failure decompensation requiring hospitalization, heart transplantation, and recurrent AM. MACE was defined as a composite of cardiovascular death (including sudden death), sustained ventricular tachycardia, ventricular fibrillation, complete atrioventricular heart block requiring a pacemaker, and cardiogenic shock. Five studies were reviewed for the prognostic value of parametric mapping parameters. After initial calculations, it appeared that studies using broader composite endpoints than only MACE introduced substantial heterogeneity. Therefore, we have additionally conducted analysis incorporating only eight studies with MACE as the endpoint. RESULTS: The presence of LGE was associated with higher odds of the composite endpoint. The unadjusted pooled OR demonstrated a significant relationship between the presence of LGE and higher chances of the composite endpoint (ORLGE(+) vs. LGE(-)[95% CI] = 3.02 [1.40, 6.51], p < 0.001) with high heterogeneity (I2 = 81.98%, p < 0.0001) On the qualitative level, results obtained in the MACE studies subgroup remained the same (ORLGE(+) vs. LGE(-)[95% CI] = 2.88 [2.01, 4.13], p < 0.0001). No clear evidence of publication bias was detected; however, power to detect small-study effects is limited and results should be interpreted cautiously. The prognostic value of parametric mapping parameters did not undergo meta-analysis and was reviewed narratively due to the shortage of the respective data. The data on the prognostic value of native T1, T2, and extracellular volume (ECV) are controversial and limited. CONCLUSIONS: Based on the findings, the presence of LGE appears to be associated with an adverse prognosis in patients with AM. However, these findings should be interpreted with caution because of substantial heterogeneity among studies and the unadjusted effect estimations. Evidence regarding the prognostic value of CMR-derived parametric mapping remains limited. Large, prospective, well-designed studies are needed to determine the incremental prognostic value of parametric mapping beyond LGE for risk stratification and outcome prediction in patients with AM.