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Prognostic utility of late gadolinium enhancement cardiac magnetic resonance imaging in coronary artery disease: a meta-analysis
Journal of Cardiovascular Magnetic Resonance volume 15, Article number: O75 (2013)
Background
Late gadolinium enhancement (LGE) cardiac MR can identify injured or scarred myocardium. However its prognostic implication remains unclear.
Objective
We sought to quantify the risk of major adverse cardiovascular events (MACE) among patients with LGE and CAD.
Methods
Two reviewers conducted a systematic search of electronic databases (MEDLINE and EMBASE) and hand searched bibliographies. Reviewers extracted data in duplicate, evaluated the quality of the studies based on a 4 point scale, and calculated pooled estimates. Out of 579 unique records screened, 115 full-text articles were assessed for eligibility. We then performed a meta-analysis on 18 eligible studies which reported on the occurrence of MACE in patients with LGE detected after a myocardial infarction.
Results
A total of 4,438 patients were included in the analysis. The overall hazard ratio (HR) for MACE was 2.65 (95% confidence intervals, CI, 1.98-3.56) for the presence of any LGE, with large amounts of heterogeneity between studies (I2, 83.5%). Furthermore, there was a continuous relationship between risk and the amount of LGE detected. For every 10% of the left ventricular mass with LGE, the risk of MACE increased by 56% (HR 1.56/10% LGE, 95% CI 1.39-1.75; I2, 63.6%). Pre-specified meta-regression analyses revealed that the HR for MACE decreased with declining ejection fraction (p=0.02) when LGE was continuous, and was inversely related to age (p<0.001) when LGE was binary.
Limitations
Studies were heterogeneous with respect to patient characteristics and the definition of MACE, which may limit interpretability and generalizability.
Conclusions
The presence and extent of LGE are independent predictors of MACE in patients with prior myocardial infarction.
Funding
Nil.
Forest Plot of risk for major adverse cardiovascular events as predicted by late gadolinium enhancement, expressed as HRs with 95% CIs.
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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Chan, R.H., Leung, A.A. & Manning, W.J. Prognostic utility of late gadolinium enhancement cardiac magnetic resonance imaging in coronary artery disease: a meta-analysis. J Cardiovasc Magn Reson 15 (Suppl 1), O75 (2013). https://doi.org/10.1186/1532-429X-15-S1-O75
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DOI: https://doi.org/10.1186/1532-429X-15-S1-O75