Skip to main content
SpringerLink
Log in

The prognostic value of late gadolinium enhancement in heart diseases: an umbrella review of meta-analyses of observational studies

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Cardiac magnetic resonance imaging (CMR) has proven itself as an accurate and robust diagnostic approach and has been widely used in the detection of various heart diseases. An increasing number of studies focusing more on the prognostic aspect of LGE-CMR arose in recent years, contributing to the redundant systematic reviews and meta-analyses in this field. By providing a bird’s eye view and performing scrupulous evidence rating, this umbrella review aims to help clinical practitioners and policy-makers interpret the results of the meta-analyses on the prognostic role of late gadolinium enhancement (LGE) in patients with heart diseases.

Methods

An umbrella review of meta-analyses of observational studies.

Results

The 11 included systematic reviews comprise 33 meta-analyses covering 11 types of heart diseases, 19 different outcomes, 23,058 subjects, and 5393 events. Thirty-one of 33 meta-analyses were found supported by weak pieces of evidence and the remaining were deemed not suggestive. The meta-analysis with a p value of 9.21 × 10−15 and 991 events was updated by strictly re-conducting the meta-analysis by Becker et al. The updated meta-analysis on the prognostic role of LGE in subjects with non-ischemic dilated cardiomyopathy (DCM) in terms of major adverse cardiovascular events (MACE) included 1131 events and was rated as highly suggestive evidence.

Conclusions

The prognostic role of LGE in DCM patients in terms of MACE is supported by highly suggestive evidence, which may facilitate the optimization of the timing of prophylactic implantable or wearable implantable cardioverter-defibrillators (ICD) considering the high risk of MACE and lower expectation of recovery.

Key Points

• Cardiac magnetic resonance imaging (CMR) has been widely used in the detection of various heart diseases. Numerous studies focusing on the prognostic aspect of LGE arose in recent years.

• The meta-analysis on the prognostic role of LGE in dilated cardiomyopathy (DCM) patients in terms of major adverse cardiovascular events (MACE) by Becker et al was updated and was deemed to be supported by highly suggestive evidence.

• The credibility of the meta-analysis supported by highly suggestive evidence may facilitate the optimization of the timing of prophylactic implantable or wearable implantable cardioverter defibrillators (ICD) considering the high risk of MACE and lower expectation of recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

AMSTAR:

A MeaSurement Tool to Assess systematic Reviews

CAD:

Coronary artery disease

CI:

Confidence interval

CMR:

Cardiac magnetic resonance imaging

DCM:

Dilated cardiomyopathy

HCM:

Hypertrophic cardiomyopathy

ICD:

Cardioverter defibrillators

LEVF:

Left ventricular ejection fraction

LGE:

Late gadolinium enhancement

MACE:

Major adverse cardiovascular events

OR:

Odds ratio

RCTs:

Randomized clinical trials

SCD:

Sudden cardiac death

References

  1. Balciunaite G, Skorniakov V, Rimkus A et al (2020) Prevalence and prognostic value of late gadolinium enhancement on CMR in aortic stenosis: meta-analysis. Eur Radiol 30:640–651

    Article  Google Scholar 

  2. Becker MAJ, Cornel JH, van de Ven PM, van Rossum AC, Allaart CP, Germans T (2018) The prognostic value of late gadolinium-enhanced cardiac magnetic resonance imaging in nonischemic dilated cardiomyopathy: a review and meta-analysis. J Am Coll Cardiol Img 11:1274–1284

    Article  Google Scholar 

  3. Chen H, Zeng J, Liu D, Yang Q (2018) Prognostic value of late gadolinium enhancement on CMR in patients with severe aortic valve disease: a systematic review and meta-analysis. Clin Radiol 73:983.e987–983.e914

    Google Scholar 

  4. Debl K, Djavidani B, Buchner S et al (2006) Delayed hyperenhancement in magnetic resonance imaging of left ventricular hypertrophy caused by aortic stenosis and hypertrophic cardiomyopathy: visualisation of focal fibrosis. Heart 92:1447–1451

    Article  CAS  Google Scholar 

  5. Duan X, Li J, Zhang Q et al (2015) Prognostic value of late gadolinium enhancement in dilated cardiomyopathy patients: a meta-analysis. Clin Radiol 70:999–1008

    Article  CAS  Google Scholar 

  6. Fenoglio JJ Jr, Pham TD, Harken AH, Horowitz LN, Josephson ME, Wit AL (1983) Recurrent sustained ventricular tachycardia: structure and ultrastructure of subendocardial regions in which tachycardia originates. Circulation 68:518–533

    Article  Google Scholar 

  7. Greenwood JP, Maredia N, Younger JF et al (2012) Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 379:453–460

    Article  Google Scholar 

  8. Grigoratos C, Barison A, Ivanov A et al (2019) Meta-analysis of the prognostic role of late gadolinium enhancement and global systolic impairment in left ventricular noncompaction. Biomed Res Int 12:2141–2151

    Google Scholar 

  9. He D, Ye M, Zhang L, Jiang B (2018) Prognostic significance of late gadolinium enhancement on cardiac magnetic resonance in patients with hypertrophic cardiomyopathy. Heart Lung 47:122–126

    Article  Google Scholar 

  10. Hulten E, Agarwal V, Cahill M et al (2016) Presence of late gadolinium enhancement by cardiac magnetic resonance among patients with suspected cardiac Sarcoidosis is associated with adverse cardiovascular prognosis: a systematic review and meta-analysis. Circ Cardiovasc Imaging 9:e005001

    PubMed  PubMed Central  Google Scholar 

  11. Ioannidis JP, Patsopoulos NA, Evangelou E (2007) Uncertainty in heterogeneity estimates in meta-analyses. BMJ 335:914–916

    Article  Google Scholar 

  12. Ioannidis JP, Trikalinos TA (2007) An exploratory test for an excess of significant findings. Clin Trials 4:245–253

    Article  Google Scholar 

  13. Kalliala I, Markozannes G, Gunter MJ et al (2017) Obesity and gynaecological and obstetric conditions: umbrella review of the literature. BMJ 359:j4511

    Article  Google Scholar 

  14. Karamitsos TD, Francis JM, Myerson S, Selvanayagam JB, Neubauer S (2009) The role of cardiovascular magnetic resonance imaging in heart failure. J Am Coll Cardiol 54:1407–1424

    Article  Google Scholar 

  15. Kramer CM (2015) Role of cardiac MR imaging in cardiomyopathies. J Nucl Med 56(Suppl 4):39s–45s

    Article  Google Scholar 

  16. Liebig C, Ayala G, Wilks J et al (2009) Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol 27:5131–5137

    Article  Google Scholar 

  17. Lipinski MJ, McVey CM, Berger JS, Kramer CM, Salerno M (2013) Prognostic value of stress cardiac magnetic resonance imaging in patients with known or suspected coronary artery disease: a systematic review and meta-analysis. J Am Coll Cardiol 62:826–838

    Article  Google Scholar 

  18. Mahrholdt H, Wagner A, Judd RM, Sechtem U, Kim RJ (2005) Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies. Eur Heart J 26:1461–1474

    Article  Google Scholar 

  19. Shea BJ, Reeves BC, Wells G et al (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358:j4008

    Article  Google Scholar 

  20. Nakahara S, Tung R, Ramirez RJ et al (2010) Characterization of the arrhythmogenic substrate in ischemic and nonischemic cardiomyopathy implications for catheter ablation of hemodynamically unstable ventricular tachycardia. J Am Coll Cardiol 55:2355–2365

    Article  Google Scholar 

  21. Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the heart failure association (HFA) of the ESC. Eur J Heart Fail 18:891–975

    Article  Google Scholar 

  22. Raina S, Lensing SY, Nairooz RS et al (2016) Prognostic value of late gadolinium enhancement CMR in systemic amyloidosis. J Am Coll Cardiol Img 9:1267–1277

    Article  Google Scholar 

  23. Riley RD, Higgins JP, Deeks JJ (2011) Interpretation of random effects meta-analyses. BMJ 342:d549

  24. Salanti G, Ioannidis JP (2009) Synthesis of observational studies should consider credibility ceilings. J Clin Epidemiol 62:115–122

    Article  Google Scholar 

  25. Schmidt A, Azevedo CF, Cheng A et al (2007) Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction. Circulation 115:2006–2014

    Article  Google Scholar 

  26. Song Y, Zhong X, Gao P et al (2020) Aspirin and its potential preventive role in cancer: an umbrella review. Front Endocrinol 11:3

    Article  Google Scholar 

  27. Sterne JA, Sutton AJ, Ioannidis JP et al (2011) Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 343:d4002

    Article  Google Scholar 

  28. Tsilidis KK, Papatheodorou SI, Evangelou E, Ioannidis JP (2012) Evaluation of excess statistical significance in meta-analyses of 98 biomarker associations with cancer risk. J Natl Cancer Inst 104:1867–1878

    Article  CAS  Google Scholar 

  29. Weng Z, Yao J, Chan RH et al (2016) Prognostic value of LGE-CMR in HCM: a meta-analysis. J Am Coll Cardiol Img 9:1392–1402

    Article  Google Scholar 

  30. Yue T, Chen BH (2019) Prognostic value of late gadolinium enhancement in predicting life-threatening arrhythmias in heart failure patients with implantable cardioverter-defibrillators: a systematic review and meta-analysis. J Magn Reson Imaging. https://doi.org/10.1002/jmri.26982

Download references

Acknowledgments

We thank Dr. Xi Zhong from the Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, for assistance in statistical analysis.

Funding

This study has received funding by 345 Talent Project in Shengjing Hospital of China Medical University.

Author information

Authors and Affiliations

  1. Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China

    Yuxue Dang & Yang Hou

Authors
  1. Yuxue Dang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yang Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yang Hou.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Yang Hou.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Xi Zhong from the Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was not required for this study; because this study is a systematic review, no individual-leveled data or information is contained.

Ethical approval

Institutional Review Board approval was not required; because this study is a systematic review, no individual-leveled data or information is contained.

Methodology

• systematic review

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 216 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dang, Y., Hou, Y. The prognostic value of late gadolinium enhancement in heart diseases: an umbrella review of meta-analyses of observational studies. Eur Radiol 31, 4528–4537 (2021). https://doi.org/10.1007/s00330-020-07437-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-020-07437-w

Keywords

Search

Navigation