Key result
Absence of infarct-pattern LGE misses angiographic CAD in ~11% of patients with unexplained LVSD.
Why the study?
Rest LGE-CMR identifies infarct-pattern scar but does not assess coronary anatomy, leaving the prevalence of angiographic CAD in adults with HFrEF or unexplained left ventricular systolic dysfunction without infarct-pattern LGE to be estimated.
Meta-Analysis (n=2,236)
Answers are grounded in this paper and cite their sources.
In adults with HFrEF or unexplained left ventricular systolic dysfunction, the absence of infarct-pattern LGE on CMR does not completely rule out significant angiographic coronary artery disease, warranting further coronary evaluation if it would alter clinical management.
AIMS: Rest late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) identifies infarct-pattern scar but does not assess coronary anatomy. We estimated the prevalence of angiographic coronary artery disease (CAD) among adults with heart failure and reduced ejection fraction (HFrEF) or otherwise unexplained left ventricular systolic dysfunction without infarct-pattern LGE. METHODS AND RESULTS: MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched to 27 July 2026. Eligible studies provided separable scar-negative denominators and corresponding angiographic CAD counts from invasive coronary angiography (ICA). Scar-negative was defined as the absence of subendocardial or transmural LGE in a coronary distribution. Random-effects logit meta-analysis used restricted maximum likelihood and Hartung-Knapp confidence intervals. Twenty-two reports representing 20 studies included 2,236 paired LGE-CMR and ICA. 818 patients had infarct-pattern scar, and 1,418 were scar-negative. Eight studies contributed 44 CAD cases among 468 scar-negative patients for ≥50% stenosis, giving a pooled prevalence of 10.8% (95% confidence interval [CI] 7.4-15.4). Five studies contributed 19 CAD cases among 271 scar-negative patients for ≥70% stenosis, giving a pooled prevalence of 7.6% (95% CI 4.4-12.6). Seven studies contributed 33 CAD cases among 679 scar-negative patients for high-risk-pattern CAD, giving a pooled prevalence of 4.9% (95% CI 2.2-10.6) and a 95% prediction interval of 0.8-24.8%. These strata represented different study subsets and were not nested. CONCLUSION: Among selected adults with HFrEF or otherwise unexplained LVSD who underwent paired LGE-CMR and ICA, absence of infarct-pattern LGE did not exclude angiographic CAD. Further coronary assessment should be considered when resolving that uncertainty would alter diagnosis or management.
No takes yet. Share an insight, caveat, or question.
Grafton‐Clarke et al. (2026) conducted a meta-analysis in Heart failure and reduced ejection fraction (HFrEF) or unexplained left ventricular systolic dysfunction (LVSD) (n=2,236). Absence of infarct-pattern late gadolinium enhancement on cardiovascular magnetic resonance (scar-negative LGE-CMR) vs. Invasive coronary angiography (ICA) was evaluated on Prevalence of angiographic coronary artery disease (≥50% stenosis, ≥70% stenosis, and high-risk-pattern CAD) among scar-negative patients (Prevalence 10.8% (≥50% stenosis), 7.6% (≥70% stenosis), 4.9% (high-risk CAD), 95% CI 7.4-15.4). Absence of infarct-pattern LGE in HFrEF/unexplained LVSD still showed pooled angiographic CAD prevalences of 10.8% (≥50% stenosis), 7.6% (≥70% stenosis), and 4.9% (high-risk CAD).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: