Prognostic utility of late gadolinium enhancement on cardiac magnetic resonance in cardiac amyloidosis: a meta-analysis

Background

Cardiac Amyloidosis (CA) is an important prognostic indicator in patients with systemic amyloidosis. Cardiac MRI has emerged as imaging modality of choice to evaluate patients with CA. Delayed hyper-enhancement cardiac magnetic resonance (DHE-CMR) provides incremental diagnostic and prognostic utility in suspected CA. We performed a meta-analysis to evaluate the prognostic role of LGE by CMR (LGE-CMR) imaging in patients with CA.

Methods

Electronic databases MEDLINE, PubMed, Embase and Cochrane were systematically searched to identify studies evaluating the association between LGE-CMR and CA. The present study was designed to systematically review and assess the association between LGE and CA. The primary end-point was all-cause mortality. Pooling of odds ratios (OR) was performed using a random-effect model. Data were included from 7 studies with a total of 503 patients and a mean follow-up of 26 months.

Results

Patients had a weighted average age of 62 years, LVEF of 57.6% and 62% were male. Cardiac Biopsy was positive for 21% patients while rest had evidence of positive extra cardiac biopsy, clinical and/or imaging features consistent for CA. LGE was present in 46% of patients. LGE positive patients had increased overall mortality compared to those without LGE (pooled OR 4.29, 95% CI 1.70 to 10.82, p = 0.002).

Conclusions

LGE in CA patients is associated with increased risk of all-cause mortality; thus detection of LGE by CMR has prognostic implications which can provide risk stratification and further management in patients with CA.

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