Author + information
- Christos A. Papanastasiou, MD, MSca,
- Damianos G. Kokkinidis, MD, MScb,
- Polydoros N. Kampaktsis, MDc,
- Iosif Bikakis, MDd,f,
- Daniela K. Cunha, MDe,f,
- Evangelos K. Oikonomou, MDf,
- John P. Greenwood, PhDg,
- Mario J. Garcia, MDh and
- Theodoros D. Karamitsos, MD, PhDa,∗ ()
- a1st Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- bDepartment of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
- cNew York Presbyterian Hospital/Weill Cornell Medical College, Department of Medicine, New York, New York
- d401 General Military Hospital of Athens, Athens, Greece
- eDepartment of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa
- fSociety of Junior Doctors, Athens, Greece
- gLeeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- hDivision of Cardiology, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
- ↵∗Address for correspondence:
Dr. Theodoros D. Karamitsos, 1st Department of Cardiology, AHEPA Hospital, 1 Stilponos Kyriakides Street, Thessaloniki 54636, Greece.
Objectives The aim of this systematic review was to explore the prognostic value of late gadolinium enhancement (LGE) in patients with aortic stenosis (AS).
Background Myocardial fibrosis is a common feature of many cardiac diseases. Cardiac magnetic resonance (CMR) has the ability to noninvasively detect regional fibrosis by using the LGE technique. Several studies have explored whether LGE is associated with adverse outcome in patients with AS.
Methods Electronic databases were searched to identify studies investigating the ability of LGE to predict all-cause mortality in patients with AS. A random effects model meta-analysis was conducted. Heterogeneity was assessed with the I2 statistic.
Results Six studies comprising 1,151 patients met our inclusion criteria. LGE was present in 49.1% of patients with AS. In the pooled analysis, LGE was found to be a strong univariate predictor of all-cause mortality (pooled unadjusted odds ratio: 2.56; 95% confidence interval: 1.83 to 3.57; I2 = 0%). Four of the included studies reported adjusted hazard ratios for mortality. LGE was independently associated with mortality, even after adjusting for baseline characteristics (pooled adjusted hazard ratio: 2.50; 95% confidence interval: 1.64 to 3.83; I2 = 0%).
Conclusions Fibrosis on LGE-CMR is a powerful predictor of all-cause mortality in patients with AS and may serve as a novel marker for risk stratification. Future studies should explore whether LGE-CMR can also be used to optimize timing of AS-related interventions.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 10, 2018.
- Revision received March 20, 2019.
- Accepted March 21, 2019.
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