Key result
Late gadolinium enhancement using cardiovascular magnetic resonance identified significant coronary artery disease with a sensitivity of 85.7%, specificity of 92.4%, and an AUC of 0.906.
Why the study?
Does late gadolinium enhancement using cardiovascular magnetic resonance accurately identify underlying coronary artery disease in patients with acute new-onset heart failure and left ventricular systolic dysfunction without clinical evidence of ischemia?
Observational (n=100)
Does late gadolinium enhancement using cardiovascular magnetic resonance accurately identify underlying coronary artery disease in patients with acute new-onset heart failure and left ventricular systolic dysfunction without clinical evidence of ischemia?
Effect estimate: AUC 0.906 (95% CI 0.814-0.998)
CMR with LGE is highly accurate for ruling out significant CAD in patients with new-onset HF and LVSD without clinical signs of ischemia, serving as a valid non-invasive alternative to angiography.
Should not yet change practice in new-onset HF; leaves open need for prospective validation of LGE-CMR versus angiography.
AIMS: We evaluated the ability of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance (CMR) to identify acute new-onset heart failure (HF) with left ventricular systolic dysfunction (LVSD), whether or not in relation to underlying coronary artery disease (CAD), in patients with no clinical evidence of associated ischaemic cardiomyopathy. METHODS AND RESULTS: Hundred consecutive patients admitted with acute new-onset decompensated HF and EF <40%, with no clinical or electrocardiographic data suggestive of CAD. The patients were classified according to the presence or absence of significant CAD (stenosis > or =70% in at least one major vessel). Twenty-one patients (21%) had significant CAD. Seventy-nine (79%) had no lesions. Eighteen of the 21 patients (85%) with CAD had subendocardial/transmural LGE. In the diagnosis of CAD, LGE has a sensitivity of 85.7% (95% CI, 80-91) and specificity of 92.4% (95% CI, 87-96), respectively, with a negative predictive value of 96% (95% CI, 90-99). It has an area under the receiver operating characteristic curve of 0.906 (95% CI, 0.814-0.998). CONCLUSION: In patients with new-onset HF and LVSD for whom there are no clinical and exploratory data suggestive of ischaemic heart disease, CMR with LGE is an excellent means of ruling out significant CAD and is a valid alternative to angiography.
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Estornell-Erill et al. (2009) conducted an observational in Acute new-onset decompensated heart failure with left ventricular systolic dysfunction (n=100). Late gadolinium enhancement using cardiovascular magnetic resonance vs. Angiography was evaluated on Diagnosis of significant coronary artery disease (stenosis ≥70% in at least one major vessel) (AUC 0.906, 95% CI 0.814-0.998). Late gadolinium enhancement using cardiovascular magnetic resonance identified significant coronary artery disease with a sensitivity of 85.7%, specificity of 92.4%, and an AUC of 0.906.
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