Purpose: The aim of this systematic review was to explore the prognostic value of late gadolinium enhancement (LGE) in patients with aortic stenosis (AS).
Methods: Electronic databases were searched to identify studies investigating the ability of LGE to predict all-cause mortality in patients with AS. A random effects model meta-analysis was conducted. Heterogeneity was assessed with I2.
Results: Six studies comprising 1,250 patients met our inclusion criteria. LGE was present in 45.3% of patients. In the pooled analysis, LGE was found to be a strong univariate predictor of all-cause mortality (pooled unadjusted OR: 2.28, 95% CI: 1.27 to 4.09, I2=61%). Four of the included studies reported adjusted HR for mortality. LGE was independently associated with mortality, even after adjusting for baseline characteristics (pooled adjusted HR: 2.50, 95% CI: 1.64 to 3.83, I2=0%).
Conclusion: Fibrosis on LGE-CMR is a powerful predictor of all-cause mortality in patients with AS and may serve as a novel marker for risk stratification. Future studies should explore whether LGE-CMR can also be used to optimize timing of AS-related interventions.