title: Late gadolinium enhancement on cardiac magnetic resonance predicts adverse cardiovascular outcomes in nonischemic cardiomyopathy: a systematic review and meta-analysis.
abstract: BACKGROUND
  Late gadolinium enhancement (LGE) by cardiac MR (CMR) is a predictor of adverse cardiovascular outcomes in patients with nonischemic cardiomyopathy (NICM). However, these findings are limited by single-center studies, small sample sizes, and low event rates. We performed a meta-analysis to evaluate the prognostic role of LGE by CMR (LGE-CMR) imaging in patients with NICM.
  
  
  RESULTS
  PubMed, Cochrane CENTRAL, and EMBASE were searched for studies looking at the prognostic value of LGE-CMR in patients with NICM. The primary end points included all-cause mortality, heart failure hospitalization, and a composite end point of sudden cardiac death (SCD) or aborted SCD. Pooling of odds ratios was performed using a random-effect model, and annualized event rates were assessed. Data were included from 9 studies with a total of 1488 patients and a mean follow-up of 30 months. Patients had a mean age of 52 years, 67% were men, and the average left ventricular ejection fraction was 37% on CMR. LGE was present in 38% of patients. Patients with LGE had increased overall mortality (odds ratio, 3.27; P<0.00001), heart failure hospitalization (odds ratio, 2.91; P=0.02), and SCD/aborted SCD (odds ratio, 5.32; P<0.00001) compared with those without LGE. The annualized event rates for mortality were 4.7% for LGE+ subjects versus 1.7% for LGE- subjects (P=0.01), 5.03% versus 1.8% for heart failure hospitalization (P=0.002), and 6.0% versus 1.2% for SCD/aborted SCD (P<0.001).
  
  
  CONCLUSIONS
  LGE in patients with NICM is associated with increased risk of all-cause mortality, heart failure hospitalization, and SCD. Detection of LGE by CMR has excellent prognostic characteristics and may help guide risk stratification and management in patients with NICM.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Sujith
authors.initials: S
authors.lastname: Kuruvilla
authors.affiliation: Department of Medicine, Division of Cardiology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Nebiyu
authors.initials: N
authors.lastname: Adenaw
authors.affiliation: Department of Medicine, Division of Cardiology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Arabindra B
authors.initials: AB
authors.lastname: Katwal
authors.affiliation: Department of Medicine, Division of Cardiology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: Department of Medicine, Division of Cardiology, University of Virginia Health System, Charlottesville, VA.|Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Kramer
authors.affiliation: Department of Medicine, Division of Cardiology, University of Virginia Health System, Charlottesville, VA.|Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA.|Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA.
authors.forename: Michael
authors.initials: M
authors.lastname: Salerno
mesh_terms: D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D003287:Contrast Media; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D057210:Delayed Diagnosis; D019786:Gadolinium DTPA; D014943:Global Health; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: cardiac magnetic resonance imaging; late gadolinium enhancement; nonischemic cardiomiopathy; prognosis