title: Prognostic value of late gadolinium enhancement in clinical outcomes for hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  The objective of this study was to perform a systematic review and meta-analysis of the predictive value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for future cardiovascular events and death in hypertrophic cardiomyopathy (HCM).
  
  
  BACKGROUND
  The utility of LGE for detecting myocardial fibrosis is well established. The prognostic value of LGE in HCM has been described in several studies, but controversy exists given the limited power of these studies to predict future events.
  
  
  METHODS
  We searched multiple databases including PubMed for studies of LGE in HCM that reported selected clinical outcomes (cardiovascular mortality, sudden cardiac death [SCD], aborted SCD, and heart failure death). We performed a systematic review of the literature and meta-analysis to determine pooled odds ratios for these clinical events.
  
  
  RESULTS
  Four studies evaluated 1,063 patients over an average follow-up of 3.1 years. The pooled prevalence of LGE was 60%. The pooled odds ratios (OR) demonstrate that LGE by CMR correlated with cardiac death (pooled OR: 2.92, 95% confidence interval [CI]: 1.01 to 8.42; p = 0.047), heart failure death (pooled OR: 5.68, 95% CI: 1.04 to 31.07; p = 0.045), and all-cause mortality (pooled OR: 4.46, 95% CI: 1.53 to 13.01; p = 0.006), and showed a trend toward significance for predicting sudden death/aborted sudden death (pooled OR: 2.39, 95% CI: 0.87 to 6.58; p = 0.091).
  
  
  CONCLUSIONS
  Late gadolinium enhancement by CMR has prognostic value in predicting adverse cardiovascular events among HCM patients. There are significant relationships between LGE and cardiovascular mortality, heart failure death, and all-cause mortality in HCM. Additionally, LGE and SCD/aborted SCD displayed a trend toward significance. The assessment of LGE by CMR has the potential to provide important information to improve risk stratification in HCM in clinical practice.
authors.affiliation: Department of Medicine, Cardiology Division, University of Virginia, Charlottesville, Virginia 22908, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Green
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Berger
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Kramer
authors.forename: Michael
authors.initials: M
authors.lastname: Salerno
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000401:mortality; D003287:Contrast Media; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D057210:Delayed Diagnosis; D005355:Fibrosis / Q000175:diagnosis; D005682:Gadolinium; D014943:Global Health; D006801:Humans; D007089:Image Enhancement; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D003287:Contrast Media; D005682:Gadolinium