Cardiovascular magnetic resonance with late gadolinium enhancement improves mortality prediction beyond echocardiography: a comparative effectiveness study

Background We tested the hypotheses that 1) ejection fraction (EF) assessed by cardiovascular magnetic resonance (CMR) is a stronger predictor of all cause mortality than EF assessed by echocardiography; and 2) CMR with late gadolinium enhancement (LGE) improves risk stratification over echocardiography EF in Cox regression models as determined by net reclassification improvement (NRI). Echocardiography with EF measurement remains the initial noninvasive imaging modality for evaluation of patients, and it is used to individualize medical, surgical, and device-based therapy. Yet, if CMR with LGE improves risk stratification compared to echocardiography, then CMR would demonstrate a potential to optimize care through improved patient selection for interventions and more efficient allocation of healthcare resources.