Prognostic value of late gadolinium enhancement on cardiac magnetic resonance imaging for non-sustained ventricular tachycardia and sudden cardiac death in hypertrophic cardiomyopathy: a meta-analysis.

OBJECTIVE

Non-sustained ventricular tachycardia (NSVT) is an independent predictor of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). This meta-analysis evaluates the prognostic value of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) for predicting NSVT and its association with SCD in HCM.

MATERIALS AND METHODS

We screened electronic databases for studies evaluating the prognostic value of LGE in predicting NSVT and SCD in HCM patients. A random-effects model estimated pooled sensitivity, specificity, accuracy, predictive values, and likelihood ratios for NSVT prediction. Association between LGE extent and NSVT incidence was analyzed using weighted mean differences (WMDs), while pooled odds ratios (ORs) with 95% CIs were calculated to assess LGE's association with SCD.

RESULTS

Among 20 studies, LGE showed a pooled sensitivity, specificity, and accuracy of 91.33% (95% CI: 88.81-93.86), 37.45% (95% CI: 31.60-43.31), and 52.86% (95% CI: 45.73-59.98), respectively, for NSVT prediction. Positive and negative likelihood ratios and predictive values were, 1.40 and 0.23, and 36.35% and 92.03%, respectively. Patients with NSVT had a significantly greater LGE extent than those without (WMD: 5.95%, 95% CI: 3.08-8.81, p < 0.0001). NSVT prevalence was 28.73% (95% CI: 20.91-36.54). Additionally, LGE presence and SCD were significantly associated (OR 3.64, 95% CI: 2.36-5.61, p < 0.00001).

CONCLUSION

LGE on CMR shows high sensitivity but limited specificity and accuracy for NSVT prediction. Moreover, LGE presence was significantly associated with SCD, and NSVT patients had greater LGE extent. Nonetheless, variability in predictive values and likelihood ratios underscores the need to combine LGE with other imaging biomarkers.

KEY POINTS

Question Can LGE on CMR predict NSVT and SCD in HCM patients? Findings LGE demonstrated high sensitivity but limited specificity for NSVT prediction. Moreover, LGE presence was significantly associated with SCD, and NSVT patients had greater LGE extent. Clinical relevance LGE on CMR is a valuable marker for NSVT prediction and SCD in HCM patients, but it is not widely integrated into clinical practice. Our study highlights the need to integrate LGE with other imaging biomarkers for improved risk stratification.