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).
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.
• 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.
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Coronary artery disease
Cardiovascular magnetic resonance
Full width half maximum
Late gadolinium enhancement
Left ventricular ejection fraction
New York Heart Association
Surgical aortic valve replacement
Transcatheter aortic valve implantation
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The authors state that this work has not received any funding.
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.
Written informed consent was not required for this study because only published data were used.
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.
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Balciunaite, G., Skorniakov, V., Rimkus, A. et al. Prevalence and prognostic value of late gadolinium enhancement on CMR in aortic stenosis: meta-analysis. Eur Radiol 30, 640–651 (2020). https://doi.org/10.1007/s00330-019-06386-3
- Magnetic resonance imaging
- Aortic stenosis