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The prognostic role of late gadolinium enhancement in patients with aortic stenosis: a systematic review and meta-analysis

Session Poster Session 2

Speaker Christos Papanastasiou

Congress : Heart Failure 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease - Epidemiology, Prognosis, Outcome
  • Session type : Poster Session
  • FP Number : P1129

Authors : C Papanastasiou (Thessaloniki,GR), D Kokkinidis (New York,US), P Kampaktsis (New York,US), I Bikakis (Athens,GR), D Cunha (Iowa City,US), E Oikonomou (Athens,GR), J Greenwood (Leeds,GB), M Garcia (New York,US), T Karamitsos (Thessaloniki,GR)

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Authors:
C Papanastasiou1 , D Kokkinidis2 , P Kampaktsis3 , I Bikakis4 , D Cunha5 , E Oikonomou6 , J Greenwood7 , M Garcia8 , T Karamitsos1 , 1Ahepa University Hospital, 1st Cardiology Department - Thessaloniki - Greece , 2Albert Einstein College of Medicine, Department of Medicine - New York - United States of America , 3Weill Cornell Medical College, Department of Medicine - New York - United States of America , 4401 Army General Hospital of Athens - Athens - Greece , 5University of Iowa, Department of Radiology - Iowa City - United States of America , 6University of Athens Medical School - Athens - Greece , 7University of Leeds, Leeds Institute for Cardiovascular and Metabolic Medicine - Leeds - United Kingdom of Great Britain & Northern Ireland , 8Albert Einstein College of Medicine, Division of Cardiology - New York - United States of America ,

Citation:

Background: Myocardial fibrosis is a common feature of many cardiac diseases. Cardiac magnetic resonance (CMR) has the ability to non-invasively detect regional fibrosis, using the LGE technique. Several studies have explored whether LGE is associated with adverse outcome in patients with AS.

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.



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