title: Prognostic Value of LGE-CMR in HCM: A Meta-Analysis.
abstract: The aims of this study included performing a meta-analysis of the predictive value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for adverse events and death in hypertrophic cardiomyopathy (HCM).
  
  
  
  CMR with LGE can identify areas of myocardial fibrosis; however, controversies remain regarding the independent prognostic importance of LGE-CMR in HCM.
  
  
  
  We searched PubMed and Web of Science for studies that investigated the prognostic value of LGE in patients with HCM. Pooled odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated to assess the role of LGE CMR in the risk stratification of HCM.
  
  
  
  Seven studies were retrieved from 393 citations for the analysis, of which 2 were eliminated because of overlapping data. In total, 2,993 patients (mean age 54.6 years; median follow-up 36.8 months) were included in the analysis. Meta-analysis showed the presence of LGE was associated with an increased risk for sudden cardiac death (SCD) (OR: 3.41; 95% CI:1.97 to 5.94; p < 0.001), all-cause mortality (OR: 1.80, 95% CI: 1.21 to 2.69; p = 0.004), cardiovascular mortality (OR: 2.93, 95% CI: 1.53 to 5.61; p = 0.001), and a trend for heart failure death (OR: 2.21, 95% CI: 0.84 to 5.80; p = 0.107). Extent of LGE was associated with an increased risk of SCD (HR: 1.56/10% LGE; 95% CI: 1.33 to 1.82; p < 0.0001), heart failure death (HR: 1.61/10% LGE; 95% CI: 1.21 to 2.13; p = 0.001), all-cause mortality (HR: 1.29/10% LGE; 95% CI: 1.09 to 1.51; p = 0.002), and cardiovascular mortality (HR: 1.57/10% LGE; 95% CI: 1.30 to 1.89; p < 0.001). After adjusting for baseline characteristics, the extent of LGE remained strongly associated with the risk of SCD (HRadjusted: 1.36/10% LGE; 95% CI: 1.10 to 1.69; p = 0.005).
  
  
  
  Quantitative LGE by CMR exhibited a substantial prognostic value in SCD events prediction, independent of baseline characteristics. Assessment of LGE can be used as an effective tool for risk stratifying patients with HCM.
authors.affiliation: Cyrus Tang Hematology Center and Ministry of Education Engineering Center of Hematological Disease, the First Affiliated Hospital, and the Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Weng
authors.affiliation: Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Jialu
authors.initials: J
authors.lastname: Yao
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Chan
authors.affiliation: Cyrus Tang Hematology Center and Ministry of Education Engineering Center of Hematological Disease, the First Affiliated Hospital, and the Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
authors.forename: Jun
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Xiangjun
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, China. Electronic address: zhouyafeng@medmail.com.cn.
authors.forename: Yafeng
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Cyrus Tang Hematology Center and Ministry of Education Engineering Center of Hematological Disease, the First Affiliated Hospital, and the Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China. Electronic address: heyang1963@163.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: He
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D003287:Contrast Media / Q000008:administration & dosage*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage*; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: cardiac magnetic resonance; hypertrophic cardiomyopathy; late gadolinium enhancement; meta-analysis; myocardial fibrosis