Noninvasive diagnosis of coronary artery disease in patients with heart failure and systolic dysfunction of uncertain etiology, using late gadolinium-enhanced cardiovascular magnetic resonance.
OBJECTIVE
We evaluated the feasibility of using late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) to distinguish left ventricular (LV) systolic dysfunction related or not to coronary artery disease (CAD) in patients with heart failure (HF) but without clinical suspicion of CAD as the underlying cause.


BACKGROUND
In patients with known CAD, LGE-CMR is capable of distinguishing LV systolic dysfunction related to CAD from dilated cardiomyopathy.


METHODS
Seventy-one patients with HF and LV systolic dysfunction, without a previous history of myocardial infarction, with neither Q waves nor clinical data suggesting CAD, underwent both LGE-CMR and coronary angiography.


RESULTS
Twenty-six patients (37%) had angiographically proven CAD (>/=70% stenosis of a major epicardial vessel) (angio [+] group), and 45 (63%) had unobstructed coronary arteries (angio [-] group). Twenty-one patients in the angio (+) group (21 of 26, 81%) showed subendocardial and/or transmural enhancement, whereas only 4 (9%) of 45 in the angio (-) group showed it (p < 0.001). In 7 patients (7 of 71, 10%), we found a different pattern of mid-wall enhancement-namely, 3 of 26 patients in the angio (+) group and 4 of 45 in the angio (-) group (11% vs. 9%, p = 0.7). Mid-wall enhancement in the angio (+) group was distributed in segments other than those which had subendocardial enhancement.


CONCLUSIONS
In patients with HF and LV systolic dysfunction without clinical suspicion of CAD, LGE-CMR is an excellent tool for classifying patients in relation to the presence or absence of underlying CAD. Thus, CMR might offer a valid alternative to coronary angiography for the detection of CAD in these patients.
Soriano
Carlos J
CJ
Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Spain.
Ridocci
Francisco
F
Estornell
Jordi
J
Jimenez
Javier
J
Martinez
Vicente
V
De Velasco
José A
JA
D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000503:physiopathology; D003287:Contrast Media / Q000008:administration & dosage*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D013599:Systole / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology
D003287:Contrast Media; D019786:Gadolinium DTPA