Accuracy of cardiac magnetic resonance imaging to rule out significant coronary artery disease in patients with systolic heart failure of unknown aetiology: Single-centre experience and comprehensive meta-analysis.
Manchuelle, Aurelie; Pontana, Francois; De Groote, Pascalet al.
2018 • In Archives of Cardiovascular Diseases, 111, p. 686-701
Angiographie coronaire; Coronaropathie; Coronary angiogram; Coronary artery disease; Heart failure; Imagerie par resonance magnetique; Insuffisance cardiaque; Late gadolinium enhancement; Magnetic resonance imaging; Rehaussement tardif
Abstract :
[en] BACKGROUND: Coronary artery disease (CAD) is the leading cause of systolic heart failure (HF). Cardiac magnetic resonance imaging (CMR) is a non-invasive technique that detects a myocardial infarction scar as subendocardial or transmural late gadolinium enhancement (st-LGE). AIM: We sought to evaluate whether a lack of st-LGE could rule out CAD in new-onset systolic HF of unknown aetiology. METHODS: We included 232 consecutive patients with new-onset HF and left ventricular ejection fraction </=35% who underwent both coronary angiography and CMR to assess HF aetiology. CAD was defined as the presence of coronary artery stenosis>/=50% on a coronary angiogram. We assessed sensitivity, specificity, and positive and negative likelihood ratios (PLR and NLR) of the presence of st-LGE to detect underlying CAD. A complementary meta-analysis of 11 studies (including ours) was also performed. RESULTS: In our study, 49 (21.1%) patients had CAD. The sensitivity and specificity of the presence of st-LGE to detect CAD were 69 and 92%, respectively. PLR and NLR were 8.47 and 0.33, respectively. In the meta-analysis, 1227 patients were included, and the prevalence of CAD ranged from 19.2 to 68.3%. Sensitivity, specificity, PLR and NLR were 87% (95% confidence interval [CI] 0.80-0.92), 93% (95% CI 0.89-0.96), 12.91 (95% CI 7.70-21.64) and 0.14 (95% CI 0.09-0.22), respectively. Altogether, 55 patients presented CAD with no st-LGE; inversely, 75 patients presented st-LGE with no CAD. CONCLUSION: With a CMR specificity of 93%, the absence of st-LGE rules out significant underlying CAD in patients with systolic HF of unknown aetiology in most cases.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Manchuelle, Aurelie
Pontana, Francois
De Groote, Pascal
Lebert, Paul
Fertin, Marie
Baijot, Marine
Hurt, Christopher
Lamblin, Nicolas
Debry, Nicolas
Schurtz, Guillaume
Pentiah, Anju Duva
Sudre, Arnaud
Remy-Jardin, Martine
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Accuracy of cardiac magnetic resonance imaging to rule out significant coronary artery disease in patients with systolic heart failure of unknown aetiology: Single-centre experience and comprehensive meta-analysis.
Publication date :
2018
Journal title :
Archives of Cardiovascular Diseases
ISSN :
1875-2136
eISSN :
1875-2128
Publisher :
Elsevier Masson, Paris, France
Volume :
111
Pages :
686-701
Peer reviewed :
Peer reviewed
Commentary :
Copyright (c) 2018. Published by Elsevier Masson SAS.
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