Prognostic utility of late gadolinium enhancement cardiac magnetic resonance imaging in coronary artery disease: a meta-analysis

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.

Figure 1

Forest Plot of risk for major adverse cardiovascular events as predicted by late gadolinium enhancement, expressed as HRs with 95% CIs.