Prognostic value of late enhancement in cardiac magnetic resonance in patients with dilated cardiomyopathy: a meta-analysis

Background

To systematically review the prognostic value of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) in patients with dilated cardiomyopathy (DCM).

Methods

A literature search was performed on Medline and Embase for original articles estimating the LGE prognostic value in patients with DCM. Original articles had to assess mortality for cardiac and non-cardiac causes, sudden cardiac death, sudden death avoided, and hospitalization for cardiac failure. Heterogeneity (I²) was evaluated using the Cochrane Q statistics: P-value <0.100 were considered significant. Pooled odd ratio (OR) and 95% confidence interval (CI: 95%) were calculated using Comprehensive Meta-Analysis.

Results

Out of 691 articles initially retrieved, 6 prospective clinical trials were selected for a total of 1,017 patients. All analyzed studies were performed using a 1.5-T MR unit. LGE was positively correlated with all considered clinical outcomes. Pooled mortality for all causes showed I²=33% p = 0.202) and OR=2.6 (95%CI 1.7-4.0; p<0.001); hospitalization for cardiac failure showed I²=24% (p=0.257) and OR=2.7 (95%CI 1.8-4.1; p<0.001); sudden cardiac death showed I²=0% (p=0.895) and OR=3.2 (95%CI 1.6-6.3; p=0.001); death for cardiac causes showed I²=0% (p=0.782) and OR=3.5 (95%CI 2.2-5.7; p<0.001); sudden death avoided showed I²=0% (p=0.815) and OR=6.3 (95%CI 3.4-11.6; p<0.001).

Conclusions

LGE at CMR in patients with CMD is closely related to a more negative prognosis if compare to patients without LGE.