Cardiovascular magnetic resonance imaging to identify left-sided chronic heart failure in stable patients with chronic obstructive pulmonary disease.
BACKGROUND
Although cardiovascular magnetic resonance imaging (CMR) is well established, its diagnostic accuracy in identifying chronic heart failure (CHF) in patients with chronic obstructive pulmonary disease (COPD) has not yet been quantified.


METHODS
Participants were recruited from a cohort of 405 patients aged >or=65 years, with mild to moderate and stable COPD. In this population, 83 (20.5%) patients had a new diagnosis of CHF, all left-sided, established by an expert panel using all available diagnostic information, including echocardiography. In a nested case-control study design, 37 consecutive COPD patients with newly detected CHF (cases) and a random sample of 41 of the remaining COPD patients (controls) received additional CMR measurements. The value of CMR in diagnosing heart failure was quantified using univariable and multivariable logistic modeling in combination with area under the receiver operating characteristic curves (ROC-area).


RESULTS
Combination of CMR measurements of left ventricular ejection fraction, indexed left and right atrial volume, and left ventricular end-systolic dimensions provided high added diagnostic value beyond clinical items (ROC-area 0.91) for identifying CHF. Left-sided measurements of CMR and echocardiography correlated well, including ejection fraction. Right ventricular mass divided by right ventricular end-diastolic volume was higher in COPD patients with CHF than in those without concomitant CHF.


CONCLUSIONS
Easily assessable morphologic and volume-based CMR measurements have excellent capacities to identify previously unknown left-sided chronic heart failure in mild to moderate COPD patients. There seems to be an adaptive tendency to concentric right ventricular hypertrophy in COPD patients with left-sided CHF.
Rutten
Frans H
FH
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands. f.h.rutten@umcutrecht.nl
Vonken
Evert J
EJ
Cramer
Maarten J
MJ
Moons
Karel G
KG
Velthuis
Birgitta B
BB
Prakken
Niek H
NH
Lammers
Jan W
JW
Grobbee
Diederick E
DE
Mali
Willem P
WP
Hoes
Arno W
AW