Association between late gadolinium enhancement and outcome in dilated cardiomyopathy: A meta-analysis

Table 1 Risk of bias assessment in the meta-analysis

Ref.	Selection				Comparability	Outcome			Total score
	Exposed cohort	Nonexposed cohort	Ascertainment of exposure	Outcome of interest		Assessment of outcome	Length of follow-up	Adequacy of follow-up
Halliday et al[6], 2019	1	1	1	1	0	1	1	1	7
Gulati et al[2], 2013	0	1	1	1	1	1	1	1	7
Behera et al[9], 2020	1	1	1	1	2	0	1	1	8
Tateishi et al[10], 2015	1	1	1	1	0	1	1	1	7
Lehrke et al[11], 2011	1	1	1	1	1	1	0	1	7
Perazzolo et al[7], 2014	1	1	1	1	2	1	1	1	9
Neilan et al[12], 2013	1	1	1	1	2	1	0	1	8
Yamada et al[13], 2014	1	1	1	1	2	0	1	1	8
Buss et al[14], 2015	1	1	1	1	1	1	1	1	8
Mikami et al[15], 2016	1	1	1	1	2	1	0	1	8
Puntmann et al[16], 2016	1	1	1	1	2	1	0	1	8
Masci et al[17], 2012	1	1	1	1	1	1	0	1	7
Šramko et al[8], 2013	1	1	1	1	2	1	1	1	9
Amzulescu et al[20], 2015	0	1	1	1	0	0	1	1	5
Alba et al[21], 2020	1	1	1	0	1	0	1	1	6
Xu et al[18], 2021	1	1	1	1	1	1	1	1	8
Barison et al[19], 2020	1	1	1	1	2	0	1	1	8
Halliday et al[4], 2017	0	1	1	1	0	1	1	1	6
Di Marco et al[22], 2021	1	1	1	0	0	0	1	1	5

The total score was 9, and the higher the score, the lower the bias, besides, scores ≤ 5 means a relative high risk of bias.

Table 2 Description of the studies included in the meta-analysis

Ref.	Type of study	Patients enrolled	Mean/median age (yr)	Male (%)	LGE present, n (%)	Mean/Median Follow-Up Time	Endpoint included in analysis	Mean/median LVEF (%)	Mean/median LVEDVi (mL/m2)
Halliday et al[6], 2019	Prospective	874	LGE negative: 51.0 ± 15.1; LGE extent (0.00%-2.55%): 52.8 ± 14.4; LGE extent (2.55%-5.10%): 53.7 ± 14.6; LGE extent (> 5.10%): 56.2 ± 14.6	588 (67.3)	300 (34.3)	4.9 yr (range, 3.5-7.0 yr)	All cause mortality; arrhythmic events: SCD and aborted SCD.	39 (range, 29-50)	LGE negative: 126.3 ± 36.6; the extent of LGE (0.00-2.55%): 147.9 ± 46.1; the extent of LGE (2.55%-5.10%): 142.8 ± 49.8; the extent of LGE (> 5.10%): 135.5 ± 37.3
Gulati et al[2], 2013	Prospective	472	51.1 ± 14.7	324 (68.6)	142 (30.1)	5.3 yr (range, 31 d-11.0 yr)	Arrhythmic events: SCD and aborted SCD; all cause mortality	37±13	135.1 ± 44.3
Behera et al[9], 2020	Retrospective	112	LGE negative: 45.5 (range, 33.0-58.7); LGE positive: 40.0 (range, 24.5-54.5)	LGE negative: 42 (61.8); LGE positive: 30 (68.2)	44 (39.3)	745 ± 320 d	Composite endpoint: All-cause mortality, resuscitated cardiac arrest, sustained VT/appropriate ICD shock, HF hospitalization	LGE negative: 31.5 (range, 28.0-36.2); LGE positive: 32.5 (range, 27.0-41.0)	LGE negative: 104.0 (range, 77.0-125.0); LGE positive: 137.0 (range, 87.5-225.2)
Tateishi et al[10], 2015	Prospective	207	50 ± 16	165 (80)	105 (50.7)	44 mo (range, 23-62 mo)	Composite endpoint: Cardiac death, cardiac transplantation, LV assist device implantation, appropriate ICD discharge for VT or VF, and rehospitalisation for HF	27 ± 11	143 ± 57
Lehrke et al[11], 2011	Prospective	184	51.55 ± 1.1	138 (75)	72 (39.1)	685 ± 30 d	Composite endpoint: Cardiac death, hospitalisation for decompensated HF, or appropriate ICD discharge	LGE negative: 44 (range, 33.1-50.9); LGE positive: 31 (range, 20.9-42.2)	LGE negative: 109 (range, 92.7-137.6); LGE positive: 133 (range, 116-161)
Perazzolo et al[7], 2014	Prospective	137	No arrhythmic events: 47 (range, 37-60); arrhythmic events: 59 (range, 43-70)	108 (78.8)	76 (55.5)	3 yr (range, 31 d-9.6 yr)	Arrhythmic events: SCD, cardiac arrest due to VF, sustained VT, or appropriate ICD intervention.	No arrhythmic events:33 (range, 28-40); arrhythmic events: 30 (range, 29-40)	No arrhythmic events: 109 (range, 87-140); arrhythmic events: 123 (range, 105-143)
Neilan et al[12], 2013	Prospective	162	55 ± 14	106 (65)	81 (50)	29 ± 18 mo	Composite endpoint: Cardiovascular death and appropriate ICD therapy; arrhythmic events: ATP, ICD discharge, and non-heart failure cardiovascular death	28 ± 9	140 ± 50
Yamada et al[13], 2014	Prospective	57	55 ± 13	40 (70.2)	25 (44)	71 ± 32 mo	Composite endpoint: Cardiac death, hospitalization for decompensated HF, or documented lethal arrhythmia, including VT and VF	LGE negative: 36 ± 13; LGE positive: 30 ± 11	LGE negative: 120 ± 39; LGE positive: 141 ± 47
Buss et al[14], 2015	Prospective	210	52 ± 15	159 (76)	79 (38)	5.3 yr	Composite endpoint: Cardiac events together with the occurrence of hospitalization due to congestive HF	36.1 ± 13.8	132 ± 48
Mikami et al[15], 2016	Prospective	118	57 ± 14	68 (58)	66 (56)	2.1 ± 1.3 yr	Composite endpoint: Cardiac mortality or appropriate ICD therapy; arrhythmic events: Appropriate ICD therapy or SCD	32 ± 12	119 ± 42
Puntmann et al[16], 2016	Prospective	637	50 (range, 37-76 yr)	395 (62)	171 (27)	22 mo (range, 19-25 mo)	All cause mortality	47 (range, 29-50)	109 (range, 89-132)
Masci et al[17], 2012	Prospective	125	59 ± 14	82 (65.6)	50 (40)	14.2 mo (range, 6.5–28.8 mo)	Composite endpoint: Cardiac death and HF hospitalization	33 ± 10	LGE negative: 124 ± 35; LGE positive: 140 ± 39
Šramko et al[8], 2013	Prospective	42	Idiopathic: 45 ± 12; inflammatory: 42 ± 8	30 (71.4)	28 (66.7)	25 ± 9 mo	Composite endpoint: Cardiac death, urgent heart transplantation, and hospitalization for worsening HF	Idiopathic DC: 22 ± 11; Inflammatory DC: 21 ± 9	Idiopathic: 137 ± 39; Inflammatory: 148 ± 46
Amzulescu et al[20], 2015	Prospective	162	55 ± 15	102 (63.0)	63 (39)	3.4 yr (range, 1.5-6.3 yr)	Composite endpoint: Cardiovascular death, heart transplantation, LV assist device implantation, resuscitated cardiac arrest, and appropriate device shocks	24.6 ± 8.4	161.6 ± 52
Alba et al[21], 2020	Retrospective	1672	56 ± 14	1185 (70.9)	650 (39)	2.3 yr (range, 1.0-4.3 yr)	Composite endpoint: All-cause mortality, heart transplantation, or left ventricular assist device implant; arrhythmic events: SCD or appropriate ICD shock	33 ± 11	118 ± 27
Xu et al[18], 2021	Prospective	412	48.0 ± 14.4	300 (72.8)	201 (48.8)	28.1 mo (range, 19.3-43.0 mo)	Composite endpoint: All-cause mortality and HF readmission; all-cause mortality	23.7 ± 9.8	185.6 ± 58.9
Barison et al[19], 2020	Prospective	183	66 (range, 56-73 yr)	134 (73)	116 (63)	30 mo (range, 10-65 mo)	Composite endpoint: Appropriate ICD shock and cardiac death; arrhythmic events: appropriate ICD shock	24 (range, 21-31)	143 (range, 120-168)
Halliday et al[4], 2017	Prospective	399	49.9 ± 15.3	254 (63.7)	101 (25.3)	4.6 yr (range, 3.5-7.0 yr)	Arrhythmic events: SCD or Aborted SCD	49.6 ± 4.9	111.1 ± 19.4
Di Marco et al[22], 2021	Retrospective	1165	58 (range, 48-68)	768 (65.9)	486 (41.7)	36 mo (range, 20-58 mo)	Arrhythmic events: Appropriate ICD therapies, sustained VT, resuscitated cardiac arrest, and sudden death	39 (range, 30-46)	118 (range, 99-142)

Values are n, mean ± SD, or n (%) unless otherwise indicated; LGE: Late gadolinium enhancement; VT: Ventricular tachycardia; VF: Ventricular fibrillation; HF: Heart failure; ICD: Implantable cardioverter-defibrillator; SCD: Sudden cardiac death; LV: Left ventricular; ATP: Anti-tachycardia pacing.