title: Diagnostic Accuracy of Cardiac Magnetic Resonance Imaging in the Evaluation of Newly Diagnosed Heart Failure With Reduced Left Ventricular Ejection Fraction.
abstract: The aim of this study was to determine the diagnostic value of cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE), cine imaging, and resting first-pass perfusion (FPP) in the evaluation for ischemic (IC) versus nonischemic (NIC) cardiomyopathy in new-onset heart failure with reduced (≤40%) left ventricular ejection fraction (HFrEF). A retrospective chart review analysis identified 83 patients from January 2009 to June 2012 referred for CMR imaging evaluation for new-onset HFrEF with coronary angiography performed within 6 months of CMR. The diagnosis of IC was established using Felker criteria on coronary angiography. CMR sequences were evaluated for the presence of patterns suggestive of severe underlying coronary artery disease as the cause of HFrEF (subendocardial and/or transmural LGE, regional wall motion abnormality on cine, regional hypoperfusion defect on resting FPP). Discriminative power was assessed using receiver operator characteristics curve analysis. Coronary angiography identified 36 patients (43%) with IC. Presence of subendocardial and/or transmural LGE alone demonstrated good discriminative power (C-statistic 0.85, 95% confidence interval 0.76 to 0.94) for the diagnosis of IC. The presence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 87% for the diagnosis of IC, whereas the absence of an ischemic pattern on both LGE and cine sequences resulted in a specificity of 94% for the diagnosis of NIC. Addition of resting FPP on a subset of patients did not improve diagnostic values. In conclusion, CMR has potential value in the diagnostic evaluation of IC versus NIC.
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York; Department of Medicine, Section of Cardiology, VA New York Harbor Health Care Center, New York, New York.
authors.forename: Eugene
authors.initials: E
authors.lastname: Won
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York; Department of Medicine, Section of Cardiology, VA New York Harbor Health Care Center, New York, New York; Department of Radiology, New York University School of Medicine, New York, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Donnino
authors.affiliation: Division of Cardiology, Department of Medicine, Medstar Georgetown University Hospital, Washington, DC.
authors.forename: Monvadi B
authors.initials: MB
authors.lastname: Srichai
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York; Department of Medicine, Section of Cardiology, VA New York Harbor Health Care Center, New York, New York.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Sedlis
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Frederick
authors.initials: F
authors.lastname: Feit
authors.affiliation: Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Linda
authors.initials: L
authors.lastname: Rolnitzky
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York; Department of Medicine, Section of Cardiology, VA New York Harbor Health Care Center, New York, New York.
authors.forename: Louis H
authors.initials: LH
authors.lastname: Miller
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Sohah N
authors.initials: SN
authors.lastname: Iqbal
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York; Department of Radiology, New York University School of Medicine, New York, New York.
authors.forename: Leon
authors.initials: L
authors.lastname: Axel
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Brian
authors.initials: B
authors.lastname: Nguyen
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: Slater
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York; Department of Medicine, Section of Cardiology, VA New York Harbor Health Care Center, New York, New York. Electronic address: binita.shah@nyumc.org.
authors.forename: Binita
authors.initials: B
authors.lastname: Shah
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D016277:Ventricular Function, Left