title: Combined coronary and late-enhanced multidetector-computed tomography for delineation of the etiology of left ventricular dysfunction: comparison with coronary angiography and contrast-enhanced cardiac magnetic resonance imaging.
abstract: OBJECTIVE
  To evaluate whether comprehensive evaluation of coronary anatomy and delayed enhancement (DE) by multidetector-computed tomography (MDCT) would allow determination of etiology of left ventricular dysfunction (LVD) as compared with coronary angiography (CA) and DE-magnetic resonance (CMR).
  
  
  RESULTS
  Seventy-one consecutive patients (50 males, 59 +/- 16 years) with LVD (ejection fraction: 26 +/- 11%) of unknown etiology underwent MDCT, LGE (late Gd-DTPA-enhanced)-CMR and CA. Patients were classified into four groups according to coronary artery disease (CAD) by CA and LGE-CMR patterns. Patients (n = 24) with CAD and transmural or sub-endocardial DE by CMR were considered having definite ischaemic LVD (group 1). Patients (n = 36) without CAD by CA and with no/atypical LGE-CMR were considered non-ischaemic LVD (group 2). Further we identified four patients with transmural DE but no CAD (group 3) and seven patients with CAD but no DE (group 4). On per-patient basis, combined coronary and DE-MDCT had excellent agreement (kappa = 0.89; P < 0.001) with CA/LGE-CMR to classify patients into the same four groups. Sensitivity, specificity and accuracy of MDCT were 97, 92 and 94%, respectively for detecting patients with definite (group 1) or likely (groups 3 and 4) ischaemic LVD.
  
  
  CONCLUSIONS
  Combined coronary and DE-MDCT can accurately differentiate ischaemic vs. non-ischaemic etiology of LVD.
authors.affiliation: Department of Cardiovascular Diseases, Division of Cardiology, Cliniques Universitaires St Luc UCL, Brussels, Belgium.
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: le Polain de Waroux
authors.forename: Anne-Catherine
authors.initials: AC
authors.lastname: Pouleur
authors.forename: Céline
authors.initials: C
authors.lastname: Goffinet
authors.forename: Agnès
authors.initials: A
authors.lastname: Pasquet
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
authors.forename: Bernhard L
authors.initials: BL
authors.lastname: Gerber