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Meta-Analysis
. 2022 Oct 11;58(10):1429.
doi: 10.3390/medicina58101429.

Long-Term Prognostic Value of Myocardial Viability by Myocardial Contrast Echocardiography in Patients after Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

Jingxin Wang  1 , Mengxi Yang  2 , Zhi Yang  3 , Lu Ye  1 , Hong Luo  1 , Yingkun Guo  4
Affiliations
Meta-Analysis

Long-Term Prognostic Value of Myocardial Viability by Myocardial Contrast Echocardiography in Patients after Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

Jingxin Wang et al. Medicina (Kaunas). .

Abstract

Background and Objectives: According to recent guidelines, myocardial contrast echocardiography (MCE) is recommended for detecting residual myocardial viability (MV). However, the long-term prognostic value of MV as assessed by MCE in identifying major adverse cardiac events (MACE) after acute myocardial infarction (AMI) remains undefined. Materials and Methods: We searched multiple databases, including PubMed, EMBASE, and Web of Science for studies on the prognostic value of MCE for clinical outcomes in AMI patients. The primary endpoints were MACEs during follow-up. Six studies that evaluated a total of 536 patients with a mean follow-up of 36.8 months were reviewed. Results: The pooled sensitivity and specificity of MCE for predicting MACEs were 0.80 and 0.78, respectively, and the summary operating receiver characteristics achieved an area under the curve of 0.84. The pooled relative risks demonstrated that the MV evaluated by MCE after AMI was correlated with a high risk for total cardiac events (pooled relative risk: 2.07; 95% confidence interval: 1.28-3.37) and cardiac death (pooled relative risk: 2.48; 95% confidence interval: 1.03-5.96). MV evaluated by MCE was a highly independent predictor of total cardiac events (pooled hazard ratio: 2.09, 95% confidence interval: 1.14-3.81) in patients after AMI. Conclusions: Residual MV evaluated by MCE may be an effective long-term prognostic tool for predicting MACE in patients after AMI that can provide moderate predictive accuracy. The assessment of MV by MCE may become an alternative technique with the potential to rapidly provide important information for improving long-term risk stratification in patients after AMI, at the bedside in clinical practice, especially for patients who cannot tolerate prolonged examinations. The PROSPERO registration number is CRD42020167565.

Keywords: acute myocardial infarction; meta-analysis; myocardial contrast echocardiography; myocardial viability; prognosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study selection process.
Figure 2
Figure 2
Forest plots of (A) pooled sensitivities, (B) specificities, and (C) summary receiver–operating characteristic curve (C) of myocardial contrast echocardiography to predict major adverse cardiac events during follow-up visits [13,14,16,17].
Figure 2
Figure 2
Forest plots of (A) pooled sensitivities, (B) specificities, and (C) summary receiver–operating characteristic curve (C) of myocardial contrast echocardiography to predict major adverse cardiac events during follow-up visits [13,14,16,17].
Figure 3
Figure 3
Forest plots of the pooled relative risks (RR) for (A) total cardiac events and (B) cardiac death, and (C) forest plot of pooled hazard ratios (HR) in patients after acute myocardial infarction [12,13,14,17,21,22].
Figure 3
Figure 3
Forest plots of the pooled relative risks (RR) for (A) total cardiac events and (B) cardiac death, and (C) forest plot of pooled hazard ratios (HR) in patients after acute myocardial infarction [12,13,14,17,21,22].
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