title: Prognostic Value of Late Gadolinium Enhancement CMR in Systemic Amyloidosis.
abstract: The aim of this study was to access the prognostic implication of late gadolinium enhancement (LGE) in patients with systemic amyloidosis undergoing cardiac magnetic resonance (CMR).
  
  
  
  Cardiac amyloidosis confers significantly worse prognosis in patients with systemic amyloidosis. CMR imaging has emerged as an attractive noninvasive modality to diagnose cardiac involvement in patients with systemic amyloidosis. We performed a systemic review and meta-analysis to evaluate the prognostic role of LGE-CMR imaging in patients with systemic amyloidosis.
  
  
  
  Electronic databases MEDLINE, PubMed, Embase, and Cochrane were systematically searched to identify studies evaluating the association between LGE-CMR and prognosis in systemic amyloidosis with cardiac involvement. The present study was designed to systematically review and assess the association between LGE and the primary endpoint of all-cause mortality. A random effects model was used to calculate a pooled odds ratio using inverse-variance weighting.
  
  
  
  Data were included from 7 studies with a total of 425 patients and a mean follow-up of 25 months. Patients had a weighted average age of 64 years and left ventricular ejection fraction of 59.2%; 67% were male. Endomyocardial biopsy was positive for amyloidosis in 20%, whereas LGE was present in 73% of patients. LGE-positive patients had increased overall mortality compared with those without LGE (pooled odds ratio: 4.96; 95% confidence interval [CI]: 1.90 to 12.93; p = 0.001). For the LGE group, the pooled death rate was 0.07 (95% CI: 0.03 to 0.19) events per year and for the LGE+ group, the rate was 0.25 (95% CI: 0.16 to 0.39 per year; p = 0.001). The proportion of patients with cardiac biopsy within each study ranged from 3% to 68%, and the relationship between LGE status and death did not vary according to cardiac biopsy proportion across studies.
  
  
  
  LGE on CMR in patients with systemic amyloidosis with known or suspected cardiac amyloidosis is associated with increased risk of all-cause mortality.
authors: Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: sameer.raina@hsc.wvu.edu.
authors: Sameer
authors: S
authors: Raina
authors: Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors: Shelly Y
authors: SY
authors: Lensing
authors: Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors: Ramez S
authors: RS
authors: Nairooz
authors: Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors: Naga Venkata K
authors: NV
authors: Pothineni
authors: Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Central Arkansas VA Health System, Little Rock, Arkansas.
authors: Abdul
authors: A
authors: Hakeem
authors: Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors: Sabha
authors: S
authors: Bhatti
authors: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors: Tarun
authors: T
authors: Pandey
mesh_terms: D000686:Amyloidosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D001706:Biopsy; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; 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 MRI; cardiac amyloidosis; late gadolinium enhancement