Prognostic value of late gadolinium enhancement on CMR in patients with severe aortic valve disease: a systematic review and meta-analysis

AIM: To evaluate the predictive value of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) in patients with severe aortic valve disease. MATERIALS AND METHODS: PubMed, EMBASE, and Web of Science were searched for studies applying LGE-CMR to assess prognostic significance in patients with severe aortic valve disease and to measure myocardial fibrosis (MF). The association of LGE with outcomes was estimated for each study by an odds ratio (OR) along with its 95% confidence interval (CI). Pooled estimates of ORs were calculated using a Mantel-Haenszel fixed-effects model. RESULTS: Six studies including 626 patients were included in the meta-analysis. The follow-up period was from 0.5 to 5.7 years. The pooled OR was 3.28 (95% CI: 2.02-5.32; p<0.001) for LGE (+) versus LGE (-) in predicting patients with aortic valve disease in all-cause mortality. The presence of LGE was associated with cardiovascular mortality (pooled OR: 3.10, 95% CI: 1.73-5.56; p<0.001). The presence of LGE was associated with all-cause mortality in patients with severe aortic stenosis after aortic valve replacement (pooled OR: 2.30, 95% CI: 1.06-4.99; p=0.036). CONCLUSION: LGE on CMR is a promising risk stratification method, as it could predict all-cause mortality and cardiovascular mortality in patients with aortic valve disease, especially for aortic stenosis. LGE-CMR also has significant prognostic value in patients after aortic valve replacement. (C) 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.