Association of late-gadolinium enhancement on cardiac magnetic resonance with cardiovascular outcomes and mortality in patients with aortic stenosis

Abstract Background Late-gadolinium enhancement (LGE) on cardiac magnetic resonance has been associated with increased risk of adverse events in various clinical settings. This association in patients with aortic stenosis is not well established. Purpose This meta-analysis assessed the association between LGE on CMR with all-cause moratlity, cardiovascular (CV) mortality, and major adverse cardiovascular events (MACE) in patients with aortic stenosis. Methods A literature search was conducted for studies reporting the association between LGE in aortic stenosis and the primary endpoint of all-cause mortality. Secondary endpoints included CV mortality and MACE. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum duration of follow-up was 12 months. Results A total of 11 studies and 2527 patients (1279 with LGE vs 1248 without LGE) were included; mean follow up was 30 months (ranging between 12 to 52 months). LGE is associated with increased risk of all-cause mortality on long-term follow-up (odds ratio 2.87, 95% confidence interval 2.03-4.04; P<0.01). Heterogeneity was low-moderate: Chi2= 12.28, df8, I2 =35%. Subgroup analysis of only patients who underwent aortic valve replacement demonstrated that LGE is associated with increased risk of all-cause mortality on long-term follow-up (OR 2.49, 95% CI 1.94-3.20; P<0.01). For secondary endpoints, LGE was not associated with a statistically significant increase in risk of CV mortality or MACE, however there is a trend toward increased risk (OR 2.43, 95% CI 0.95-6.23; P = 0.06; OR 2.33, 95% CI 0.86-6.28; P=0.09). Conclusions Our results suggest that LGE is associated with increased risk of all-cause mortality in patients with aortic stenosis regardless of whether aortic valve replacement is performed. LGE was not associated with a statistically significant increased risk of CV mortality or MACE, however additional high quality prospective studies are needed to further evaluate these endpoints.