Prognostic Value of LGE-CMR in HCM: A Meta-Analysis.

OBJECTIVES: The aims of this study included performing a meta-analysis of the predictive value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for adverse events and death in hypertrophic cardiomyopathy (HCM).

BACKGROUND: CMR with LGE can identify areas of myocardial fibrosis; however, controversies remain regarding the independent prognostic importance of LGE-CMR in HCM.

METHODS: We searched PubMed and Web of Science for studies that investigated the prognostic value of LGE in patients with HCM. Pooled odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated to assess the role of LGE CMR in the risk stratification of HCM.

RESULTS: Seven studies were retrieved from 393 citations for the analysis, of which 2 were eliminated because of overlapping data. In total, 2,993 patients (mean age 54.6 years; median follow-up 36.8 months) were included in the analysis. Meta-analysis showed the presence of LGE was associated with an increased risk for sudden cardiac death (SCD) (OR: 3.41; 95% CI:1.97 to 5.94; p < 0.001), all-cause mortality (OR: 1.80, 95% CI: 1.21 to 2.69; p = 0.004), cardiovascular mortality (OR: 2.93, 95% CI: 1.53 to 5.61; p = 0.001), and a trend for heart failure death (OR: 2.21, 95% CI: 0.84 to 5.80; p = 0.107). Extent of LGE was associated with an increased risk of SCD (HR: 1.56/10% LGE; 95% CI: 1.33 to 1.82; p < 0.0001), heart failure death (HR: 1.61/10% LGE; 95% CI: 1.21 to 2.13; p = 0.001), all-cause mortality (HR: 1.29/10% LGE; 95% CI: 1.09 to 1.51; p = 0.002), and cardiovascular mortality (HR: 1.57/10% LGE; 95% CI: 1.30 to 1.89; p < 0.001). After adjusting for baseline characteristics, the extent of LGE remained strongly associated with the risk of SCD (HRadjusted : 1.36/10% LGE; 95% CI: 1.10 to 1.69; p = 0.005).

CONCLUSIONS: Quantitative LGE by CMR exhibited a substantial prognostic value in SCD events prediction, independent of baseline characteristics. Assessment of LGE can be used as an effective tool for risk stratifying patients with HCM.