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European Radiology
Published in: European Radiology 1/2020

01-01-2020 | Transcatheter Aortic Valve Implantation | Cardiac

Prevalence and prognostic value of late gadolinium enhancement on CMR in aortic stenosis: meta-analysis

Authors: Giedre Balciunaite, Viktor Skorniakov, Arnas Rimkus, Tomas Zaremba, Darius Palionis, Nomeda Valeviciene, Audrius Aidietis, Pranas Serpytis, Kestutis Rucinskas, Peter Sogaard, Sigita Glaveckaite

Published in: European Radiology | Issue 1/2020

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Abstract

Objectives

The aim of this study was to investigate the prevalence and prognostic value of late gadolinium enhancement (LGE), as assessed by cardiovascular magnetic resonance (CMR) imaging, in patients with aortic stenosis.

Methods and results

A systematic search of PubMed and EMBASE was performed, and observational cohort studies that analysed the prevalence of LGE and its relation to clinical outcomes in patients with aortic stenosis were included. Odds ratios were used to measure an effect of the presence of LGE on both all-cause and cardiovascular mortality. Nineteen studies were retrieved, accounting for 2032 patients (mean age 69.8 years, mean follow-up 2.8 years). We found that LGE is highly prevalent in aortic stenosis, affecting half of all patients (49.6%), with a non-infarct pattern being the most frequent type (63.6%). The estimated extent of focal fibrosis, expressed in % of LV mass, was equal to 3.83 (95% CI [2.14, 5.52], p < 0.0001). The meta-analysis showed that the presence of LGE was associated with increased all-cause (pooled OR [95% CI] = 3.26 [1.72, 6.18], p = 0.0003) and cardiovascular mortality (pooled OR [95% CI] = 2.89 [1.90, 4.38], p < 0.0001).

Conclusions

LGE by CMR is highly prevalent in aortic stenosis patients and exhibits a substantial value in all-cause and cardiovascular mortality prediction. These results suggest a potential role of LGE in aortic stenosis patient risk stratification.

Key Points

• Up to the half of aortic stenosis patients are affected by myocardial focal fibrosis.
• Sixty-four percent of focal fibrosis detected by LGE-CMR is non-infarct type.
• The presence of focal fibrosis triples all-cause and cardiovascular mortality.
Appendix
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Metadata
Title
Prevalence and prognostic value of late gadolinium enhancement on CMR in aortic stenosis: meta-analysis
Authors
Giedre Balciunaite
Viktor Skorniakov
Arnas Rimkus
Tomas Zaremba
Darius Palionis
Nomeda Valeviciene
Audrius Aidietis
Pranas Serpytis
Kestutis Rucinskas
Peter Sogaard
Sigita Glaveckaite
Publication date
01-01-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06386-3

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