Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Nov 28, 2023; 15(11): 324-337
Published online Nov 28, 2023. doi: 10.4329/wjr.v15.i11.324
Association between late gadolinium enhancement and outcome in dilated cardiomyopathy: A meta-analysis
Xin-Yi Feng, Wen-Feng He, Tian-Yue Zhang, Ling-Li Wang, Fan Yang, Yu-Ling Feng, Chun-Ping Li, Rui Li
Xin-Yi Feng, Tian-Yue Zhang, Ling-Li Wang, Fan Yang, Yu-Ling Feng, Chun-Ping Li, Rui Li, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Wen-Feng He, Department of Cardiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Co-first authors: Xin-Yi Feng and Wen-Feng He.
Author contributions: Feng XY participated in the study design, contributed to data analysis and interpretation, and drafted the manuscript; He WF contributed to the preparation, editing and review of the manuscript; Zhang TY carried out data acquisition, performed data analysis and interpretation and edited the manuscript; Wang LL, Feng YL, and Li CP carried out data acquisition and performed data analysis and interpretation; Li R contributed to quality control of data and algorithm, and editing and review of the manuscript; All authors read and approved the final manuscript.
Supported by the Research Grant of the National Natural Science Foundation of China, No. 81801674; Sichuan Province Science and Technology Support Program, No. 2021YJ0242.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rui Li, PhD, Doctor, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Maoyuan South Road, Shunqing District, Nanchong 637000, Sichuan Province, China. ddtwg_nsmc@163.com
Received: August 17, 2023
Peer-review started: August 17, 2023
First decision: September 14, 2023
Revised: September 29, 2023
Accepted: October 23, 2023
Article in press: October 23, 2023
Published online: November 28, 2023
Processing time: 98 Days and 20.3 Hours
ARTICLE HIGHLIGHTS
Research background

LGE as a prognostic indicator of dilated cardiomyopathy (DCM) has been extensively studied, and several new metrics of late gadolinium enhancement (LGE), such as its extent, location, and pattern, have emerged. However, whether some indicators are protective or risk factors and whether the combination of left ventricular ejection fraction (LVEF) strata and LGE has a better predictive value remains controversial; therefore, further discussion is required, and more precise risk stratification should be explored.

Research motivation

This meta-analysis aimed to detect the predictive performance of the extent, location, and pattern of LGE, to compare and screen these new indicators of LGE, and provide novel concepts for improving the risk stratification algorithm for adverse outcomes of DCM.

Research objectives

The research objectives of this meta-analysis were to investigate the associations between the positivity and extent, location, and pattern of LGE derived from CMR and multiple outcomes. We found that the presence of LGE was associated with an increased risk of multiple adverse outcomes (all-cause mortality, arrhythmic events, and composite endpoints). Furthermore, an increase in the extent of LGE and a different location and pattern of LGE may impact the prognosis. Although the current studies and meta-analyses mainly focus on the relationship between the presence of LGE and prognosis, our study found that LGE is a stronger predictor of arrhythmic events in patients with greater LVEF, and that the different types of LGE were equally predictive, which suggested that these new indicators and their combinations may help improve the risk stratification.

Research methods

We followed the guidelines of PRISMA-NMA, registered with PROSPERO, and extracted data from databases recommended by the Cochrane Handbook. After discussion, we reached a consensus and classified the endpoints into three; the pooled HRs and 95%CIs obtained by using STATA were applied to evaluate the effectiveness of the new metrics of LGE. The Newcastle–Ottawa Quality Assessment Scale was used for quality assessment. Publication bias was assessed using Egger’s and Begg’s tests, and a sensitivity analysis was performed using the leave-one-out method, to assess the stability of the results.

Research results

CMR-LGE is a strong prognostic marker for patients with DCM. The extent, location, and pattern of LGE provided additional information for risk stratification. Further studies are needed to determine whether free-wall LGE is a protective or risk factor, and whether the focal or sub-epicardial pattern of LGE has predictive value.

Research conclusions

CMR-LGE is a strong prognostic marker for patients with DCM. The extent, location, and pattern of LGE provided additional information for risk stratification. Further studies are needed to determine whether free-wall LGE is a protective or risk factor, and whether the focal or sub-epicardial pattern of LGE has predictive value.

Research perspectives

The prognostic value of different locations and patterns of LGE needs to be confirmed in future studies, and the combined predictive value of these predictors warrants further exploration.