Late Gadolinium Enhancement Magnetic Resonance Imaging (MRI) for Predicting Left Ventricular Reverse Remodeling in Non-Ischemic Cardiomyopathy: A Systematic Review and Meta-Analysis.

Background/

Objectives

Late gadolinium enhancement (LGE)-MRI has proven utility in prognosticating outcomes in patients with non-ischemic cardiomyopathy (NICM). However, evidence regarding its ability to predict responsiveness to optimal medical therapy remains insufficient. This study conducted a meta-analysis to evaluate the predictive utility of LGE-MRI for left ventricular reverse remodeling (LVRR) in response to pharmacological therapy.

Methods

Data from 1092 NICM patients across 13 studies were included in the analysis. To assess the predictive ability of LGE-MRI for LVRR following optimal medical therapy, a pooled odds ratio was calculated using an inverse variance random-effects meta-analysis. Subgroup analyses were performed by stratifying patients based on the presence or absence of left ventricular dilation and by LVEF (<30% vs. ≥30%).

Results

The pooled odds ratio of the absence of LGE for predicting LVRR in NICM was 3.72 (95% CI: 2.83-4.90, I2 = 0, P for heterogeneity = 0.54). A comparison of pooled odds ratios between dilated cardiomyopathy (DCM) and NICM showed no significant difference (p = 0.16). A subgroup analysis in NICM based on the left ventricular ejection fraction (LVEF) demonstrated no significant difference in odds ratios between patients with LVEF <30% (OR: 2.96, 95% CI: 1.80-4.87) and those with LVEF ≥30% (OR: 3.97, 95% CI: 2.97-5.31), (p = 0.13).

Conclusions

This meta-analysis suggested that LGE-MRI serves as a reliable predictor of LVRR in patients with NICM, regardless of left ventricular dilation or baseline LVEF classification.