Meta-Analysis of Prognostic Role of LGE in Aortic Stenosis

Jul 26, 2019
Font Size
A
A
A
Authors:
Papanastasiou CA, Kokkinidis DG, Kampaktsis PN, et al.
Citation:
The Prognostic Role of Late Gadolinium Enhancement in Aortic Stenosis: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2019;Jul 11:[Epub ahead of print].
Summary By:
Venkatesh Locharla Murthy, MD, PhD, FACC

Study Questions:

What is the prognostic value of myocardial scar, as defined by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (MRI) in patients with aortic stenosis?

Methods:

This was a registered systematic review and meta-analysis of studies comparing mortality in patients with aortic stenosis who did or did not have LGE on MRI through August 2018.

Results:

Data from six studies were combined and meta-analyzed comprising 1,151 patients, of which 49% (n = 565) had LGE. Among patients with LGE, 25.7% died (n = 145) compared to 11.4% (n = 67) of those without LGE. The combined unadjusted odds ratio for all-cause mortality was 2.56 (95% confidence interval, 18.3-3.57). Evaluation of the four studies, which reported adjusted analysis, resulted in similar odds ratios.

Conclusions:

Myocardial scar as evaluated by LGE on cardiac MRI is a powerful predictor of all-cause death in patients with aortic stenosis.

Perspective:

This paper adds to a long list of studies demonstrating a strong link between LGE and adverse outcomes. What is unclear is whether the presence of LGE should prompt earlier referral to aortic valve replacement, especially among patients with asymptomatic severe aortic stenosis. This tantalizing hypothesis is being tested in patients with the currently ongoing EVOLVED (Early Valve Replacement Guided by Biomarkers of Left Ventricular Decompensation in Asymptomatic Patients with Severe Aortic Stenosis) trial.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Magnetic Resonance Imaging

Keywords: Aortic Valve Stenosis, Cardiac Surgical Procedures, Diagnostic Imaging, Gadolinium, Heart Valve Diseases, Magnetic Resonance Imaging, Myocardium, Prognosis, Transcatheter Aortic Valve Replacement


< Back to Listings