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Late Gadolinium Enhancement in Aortic Stenosis
Study Questions:
What is the prognostic value of cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging in aortic stenosis (AS)?
Methods:
This meta-analysis included studies reporting comparative mortality data for AS patients with and without LGE on contrast-enhanced CMR. Pooled unadjusted odds ratios (ORs) and adjusted hazard ratios (HRs) were calculated, and between-study heterogeneity was assessed with the I2 statistic.
Results:
A total of 577 studies were screened, and six met inclusion criteria. In four studies, all patients had severe AS, while patients with lesser degrees of AS were included in the other two studies. LGE was assessed quantitatively in five studies (three using the full-width half maximum technique, two using signal intensity >2.4 standard deviations above remote myocardium). A total of 1,151 patients were included, 565 (49.1%) of whom were LGE-positive. LGE was associated with advanced age, male gender, and diabetes mellitus. All six studies reported unadjusted ORs for mortality, and in pooled analysis, LGE was associated with all-cause mortality (unadjusted OR, 2.56; 95% confidence interval [CI], 1.83-3.57; I2 = 0%). Four studies reported adjusted HR for mortality. In pooled analyses, LGE was associated with all-cause mortality (adjusted HR, 2.50; 95% CI, 1.64-3.83; I2 = 0% for midwall LGE and adjusted HR, 2.36; 95% CI, 1.54-3.62; I2 = 0% for infarct-pattern LGE).
Conclusions:
The authors concluded that LGE is a strong predictor of all-cause mortality in AS.
Perspective:
LGE in noninfarct patterns is indicative of focal myocardial fibrosis, which may result from a chronic high-afterload state in AS patients. There is growing interest in LGE as an imaging biomarker for risk stratification in asymptomatic severe AS. However, it is important to note that diffuse fibrosis is not readily appreciable with LGE imaging; advanced CMR techniques such as myocardial T1 mapping would be needed to detect this.
Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Valvular Heart Disease, Heart Failure and Cardiac Biomarkers, Magnetic Resonance Imaging
Keywords: Aortic Valve Stenosis, Biomarkers, Cardiomyopathies, Diagnostic Imaging, Diabetes Mellitus, Fibrosis, Gadolinium, Heart Valve Diseases, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Myocardium, Risk Assessment
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