OBJECTIVES: The objective of this study was to perform a systematic review and 
meta-analysis of the predictive value of late gadolinium enhancement (LGE) 
cardiac magnetic resonance (CMR) for future cardiovascular events and death in 
hypertrophic cardiomyopathy (HCM).
BACKGROUND: The utility of LGE for detecting myocardial fibrosis is well 
established. The prognostic value of LGE in HCM has been described in several 
studies, but controversy exists given the limited power of these studies to 
predict future events.
METHODS: We searched multiple databases including PubMed for studies of LGE in 
HCM that reported selected clinical outcomes (cardiovascular mortality, sudden 
cardiac death [SCD], aborted SCD, and heart failure death). We performed a 
systematic review of the literature and meta-analysis to determine pooled odds 
ratios for these clinical events.
RESULTS: Four studies evaluated 1,063 patients over an average follow-up of 3.1 
years. The pooled prevalence of LGE was 60%. The pooled odds ratios (OR) 
demonstrate that LGE by CMR correlated with cardiac death (pooled OR: 2.92, 95% 
confidence interval [CI]: 1.01 to 8.42; p = 0.047), heart failure death (pooled 
OR: 5.68, 95% CI: 1.04 to 31.07; p = 0.045), and all-cause mortality (pooled OR: 
4.46, 95% CI: 1.53 to 13.01; p = 0.006), and showed a trend toward significance 
for predicting sudden death/aborted sudden death (pooled OR: 2.39, 95% CI: 0.87 
to 6.58; p = 0.091).
CONCLUSIONS: Late gadolinium enhancement by CMR has prognostic value in 
predicting adverse cardiovascular events among HCM patients. There are 
significant relationships between LGE and cardiovascular mortality, heart 
failure death, and all-cause mortality in HCM. Additionally, LGE and SCD/aborted 
SCD displayed a trend toward significance. The assessment of LGE by CMR has the 
potential to provide important information to improve risk stratification in HCM 
in clinical practice.