Late Gadolinium Enhancement on CMR Predicts Adverse Cardiovascular Outcomes in Non-ischemic Cardiomyopathy: A Systematic Review and Meta-analysis
Background—LGE by CMR is a predictor of adverse cardiovascular outcomes in non-ischemic cardiomyopathy (NICM) patients. However, these findings are limited by single center studies, small sample sizes, and low event rates. We performed a meta-analysis to evaluate the prognostic role of late-gadolinium enhancement by cardiac magnetic resonance (LGE-CMR) imaging in NICM patients.
Methods and Results—PubMed, Cochrane CENTRAL and EMBASE were searched for studies looking at the prognostic value of LGE-CMR in NICM patients. The primary end-points included all-cause mortality, heart failure hospitalization (HFH), and a composite end point of sudden cardiac death (SCD) or aborted SCD. Pooling of odds ratios (OR) was performed using a random-effect model and annualized event rates (AER) were assessed. Data was included from 9 studies with a total of 1,488 patients and a mean follow-up of 30 months. Patients had a mean age of 52 years, 67% were male and the average LVEF was 37% on CMR. LGE was present in 38% of patients. Patients with LGE had increased overall mortality (OR 3.27, p<0.00001), HFH (OR 2.91, p=0.02), and SCD/aborted SCD (OR 5.32, p<0.00001) when compared with those without LGE. The AERs for mortality were 4.7% for LGE+ subjects vs. 1.7% for LGE- subjects (p=0.01), 5.03% vs. 1.8% for HFH (p=0.002), and 6.0% vs. 1.2% for SCD/aborted SCD (p<0.001).
Conclusions—LGE in NICM patients is associated with increased risk of all-cause mortality, HFH, and SCD. Detection of LGE by CMR has excellent prognostic characteristics and may help guide risk stratification and management in NICM patients.
- Received September 4, 2013.
- Accepted December 10, 2013.