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Prevalence and prognostic value of late gadolinium enhancement on CMR in aortic stenosis: meta-analysis

  • Giedre BalciunaiteEmail author
  • Viktor Skorniakov
  • Arnas Rimkus
  • Tomas Zaremba
  • Darius Palionis
  • Nomeda Valeviciene
  • Audrius Aidietis
  • Pranas Serpytis
  • Kestutis Rucinskas
  • Peter Sogaard
  • Sigita Glaveckaite
Cardiac

Abstract

Objectives

The aim of this study was to investigate the prevalence and prognostic value of late gadolinium enhancement (LGE), as assessed by cardiovascular magnetic resonance (CMR) imaging, in patients with aortic stenosis.

Methods and results

A systematic search of PubMed and EMBASE was performed, and observational cohort studies that analysed the prevalence of LGE and its relation to clinical outcomes in patients with aortic stenosis were included. Odds ratios were used to measure an effect of the presence of LGE on both all-cause and cardiovascular mortality. Nineteen studies were retrieved, accounting for 2032 patients (mean age 69.8 years, mean follow-up 2.8 years). We found that LGE is highly prevalent in aortic stenosis, affecting half of all patients (49.6%), with a non-infarct pattern being the most frequent type (63.6%). The estimated extent of focal fibrosis, expressed in % of LV mass, was equal to 3.83 (95% CI [2.14, 5.52], p < 0.0001). The meta-analysis showed that the presence of LGE was associated with increased all-cause (pooled OR [95% CI] = 3.26 [1.72, 6.18], p = 0.0003) and cardiovascular mortality (pooled OR [95% CI] = 2.89 [1.90, 4.38], p < 0.0001).

Conclusions

LGE by CMR is highly prevalent in aortic stenosis patients and exhibits a substantial value in all-cause and cardiovascular mortality prediction. These results suggest a potential role of LGE in aortic stenosis patient risk stratification.

Key Points

• Up to the half of aortic stenosis patients are affected by myocardial focal fibrosis.

• Sixty-four percent of focal fibrosis detected by LGE-CMR is non-infarct type.

• The presence of focal fibrosis triples all-cause and cardiovascular mortality.

Keywords

Magnetic resonance imaging Aortic stenosis Fibrosis Prognosis Meta-analysis 

Abbreviations

AS

Aortic stenosis

CAD

Coronary artery disease

CMR

Cardiovascular magnetic resonance

FWHM

Full width half maximum

LGE

Late gadolinium enhancement

LV

Left ventricular

LVEF

Left ventricular ejection fraction

NYHA

New York Heart Association

SAVR

Surgical aortic valve replacement

TAVI

Transcatheter aortic valve implantation

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Peter Sogaard, MD, PhD.

Conflict of interest

The authors state that they have no conflict of interest.

Statistics and biometry

One of the authors has significant statistical expertise—Assoc. Prof. Viktor Skorniakov, PhD.

Informed consent

Written informed consent was not required for this study because only published data were used.

Ethical approval

Institutional Review Board approval was not required for this study because only published data were used.

Study subjects or cohorts overlap

Studies with possibly overlapping data were excluded from the analysis.

Methodology

• Meta-analysis

Supplementary material

330_2019_6386_MOESM1_ESM.docx (83 kb)
ESM 1 (DOCX 83 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Giedre Balciunaite
    • 1
    Email author
  • Viktor Skorniakov
    • 2
  • Arnas Rimkus
    • 1
  • Tomas Zaremba
    • 1
    • 3
  • Darius Palionis
    • 4
  • Nomeda Valeviciene
    • 4
  • Audrius Aidietis
    • 1
  • Pranas Serpytis
    • 1
  • Kestutis Rucinskas
    • 1
  • Peter Sogaard
    • 1
    • 3
  • Sigita Glaveckaite
    • 1
  1. 1.Clinic of Cardiovascular Diseases, Institute of Clinical MedicineVilnius University Faculty of MedicineVilniusLithuania
  2. 2.Faculty of Mathematics and Informatics, Institute of Applied MathematicsVilnius UniversityVilniusLithuania
  3. 3.Aalborg University HospitalClinical Institute of Aalborg UniversityAalborgDenmark
  4. 4.Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical SciencesVilnius University Faculty of MedicineVilniusLithuania

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