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Prognostic Value of LGE-CMR in HCM: A Meta-Analysis
Zhen Weng1, Jialu Yao2, Raymond H Chan3
1Cyrus Tang Hematology Center and Ministry of Education Engineering Center of Hematological Disease, the First Affiliated Hospital, and the Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
Insights
Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) significantly predicts adverse events and death in hypertrophic cardiomyopathy (HCM). This LGE assessment is a valuable tool for risk stratifying HCM patients.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiovascular Research
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart disease characterized by myocardial thickening.
- Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) visualizes myocardial fibrosis.
- The independent prognostic significance of LGE in HCM remains debated.
Purpose of the Study:
- To perform a meta-analysis evaluating the predictive value of LGE-CMR for adverse events and mortality in HCM patients.
- To determine if LGE-CMR can effectively stratify risk in individuals with HCM.
Main Methods:
- A systematic literature search was conducted on PubMed and Web of Science for prognostic studies of LGE in HCM.
- Pooled odds ratios (ORs) and hazard ratios (HRs) were calculated to assess the association between LGE and adverse outcomes.
- Seven studies including 2,993 patients were analyzed.
Main Results:
- The presence of LGE was associated with increased risks of sudden cardiac death (SCD), all-cause mortality, and cardiovascular mortality.
- The extent of LGE showed a significant association with increased risks of SCD, heart failure death, all-cause mortality, and cardiovascular mortality.
- Adjusted analysis confirmed that the extent of LGE independently predicted SCD risk.
Conclusions:
- Quantitative LGE by CMR has substantial prognostic value for predicting SCD events in HCM.
- LGE assessment is an effective tool for risk stratification in patients with hypertrophic cardiomyopathy.
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.
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