Abstract 12236: Reduced Predictive Value of Scar Imaging by Cardiac MRI To Predict Death or Myocardial Infarction in Women with Known or Suspected CAD: A Meta-Analysis
Background: The role of cardiac magnetic resonance (CMR) imaging using late gadolinium enhancement (LGE) to identify myocardial scar has been proposed as a predictor of cardiac events beyond traditional markers of adverse outcome. The objective was to estimate the value of LGE imaging in predicting mortality and myocardial infarction (MI) in patients with known or suspected coronary artery disease.
Methods: A systemic review of English and non-English articles using PUBMED and EMBASE (1985 to date) was performed. Search concepts included terms related to magnetic resonance imaging, gadolinium, mortality, myocardial infarction and prognosis as mesh terms or text words. Cohort studies of patients with known or suspected coronary artery disease who underwent LGE imaging by CMR that examined all-cause mortality, cardiac mortality or MI during a minimum follow-up of 6 months were selected. Data were extracted from articles independently by 2 authors using predefined data fields, including study quality indicators.
Results: Five cohort studies, including 2935 patients, met our inclusion criteria. All analyses were based on random effects models. There was evidence of heterogeneity in the included studies (Q = 5.649, df = 4, p = 0.227; I2 statistic = 29.19%), although its magnitude is small. The presence of LGE was associated with an increased probability of death or MI (HR 5.003 95%, CI 3.024-8.278, p < 0.001). Fixed and random effects models are presented in Figure 1A. The hazard ratio for death and MI in LGE positive patients decreased with an increasing proportion of women in study samples (slope estimate −8.64, 95% CI −16.1 to −1.23, p = 0.02, Figure 1B).
Conclusion: CMR imaging using LGE is a predictor of mortality and MI in patients with known and suspected coronary artery disease. This predictive value of myocardial scar appears to be more pronounced in male populations. Other risk factors should be sought to help with risk stratification of women with known or suspected CAD.
- © 2011 by American Heart Association, Inc.