Elsevier

Progress in Cardiovascular Diseases

Volume 54, Issue 3, November–December 2011, Pages 215-229
Progress in Cardiovascular Diseases

Late Gadolinium Enhancement CMR Predicts Adverse Cardiovascular Outcomes and Mortality in Patients With Coronary Artery Disease: Systematic Review and Meta-Analysis

https://doi.org/10.1016/j.pcad.2011.07.003Get rights and content

Abstract

Cardiovascular magnetic resonance (CMR) has a recognized role in diagnosing and monitoring coronary artery disease (CAD). Multiple studies have shown that CMR can predict adverse outcomes. We reviewed contemporary available literature to establish the role of CMR with late gadolinium enhancement (LGE) in predicting mortality and major adverse cardiac events (MACEs) in patients with CAD. Meta-analysis of available prospective studies showed that the presence of LGE increases the hazards of death by more than 4 times and of MACE by almost 4 times. The size of LGE (per gram or percent) increases the hazards of death and MACE by 4% and 5%, respectively. The presence and size of LGE predict mortality and MACE in CAD. Various parameters derived from LGE images enhance the predictive value. Large randomized controlled trials are needed to establish the actual value of LGE and other derived parameters in the wider population.

Section snippets

Background/Introduction

Coronary artery disease (CAD) is one of the most common diseases and causes of mortality in the modern world. Cardiovascular magnetic resonance (CMR) has a recognized role in diagnosing and monitoring CAD by assessing left ventricular (LV) function, myocardial perfusion, myocardial infarction (MI), and myocardial viability. Multiple studies have assessed the role of CMR modalities in predicting outcomes.1, 2, 3, 4 One recent meta-analysis summarized available literature on perfusion CMR as a

Methods

This systematic review was carried out using the methodology described by the Centre for Reviews and Dissemination of the University of York.6 A detailed review protocol was agreed upon before performing the review.

Results

Our initial database and literature searches identified 312 citations from which 133 were obtained for full-text review after removing duplicate studies and ones that did not describe the use of CMR. Sixty-six papers were rejected because they did not meet the basic criteria (CMR or LGE or CAD); a further 43 articles did not describe the prediction of mortality or MACE. One study was reported as a poster and a manuscript; thus, only the latter was included. Two references were excluded from the

Discussion

This systematic review is the first systematic review and meta-analysis summarizing the value of LGE in CAD and was carried out according to the methodology described by the Centre for Reviews and Dissemination of the University of York6 and supported by additional literature focusing on methodology of meta-analysis.29, 31

This review indicates that the presence of LGE on CMR is a strong predictor of mortality and MACE in patients with CAD. Meta-analysis of available prospective studies showed

Conclusions

The presence and size of LGE on CMR predict mortality and major adverse cardiovascular events in patients with CAD. Various parameters derived from LGE images seem to add value to predicting mortality and adverse cardiovascular events. Large RCTs and CSs are needed to establish the actual value of LGE and other parameters in the wider population.

Statement of Conflict of Interest

All authors declare that there are no conflicts of interest.

Acknowledgments

F. Zemrak and S.E. Petersen gratefully acknowledge the funding from the Barts and The London National Institute for Health Research Cardiovascular Biomedical Research Unit. The authors would like to thank Ms Helen Elwell from the British Medical Association Library in London for her help with our database search and Dr Jane Batchelor for her input in editing.

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