Usefulness of late gadolinium enhancement MRI combined with stress imaging in predictive significant coronary stenosis in new-diagnosed left ventricular dysfunction.
BACKGROUND
To evaluate the accuracy of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) and imaging stress test in predicting significant coronary artery disease (CAD) in left ventricular (LV) dysfunction.


METHODS
We enrolled 187 consecutive out-patients (61±17years) with new evidence of depressed (<45%) ejection fraction and no history of previous heart diseases and absence of Q-waves. All patients underwent coronary angiography (CA) and to LGE-CMR examination to identify ischemic and non-ischemic LGE. All patients underwent stress imaging to determine the presence of myocardial ischemia.


RESULTS
Ischemic-LGE was found in 83 patients and non-ischemic-LGE in 104. Significant CAD on CA was found in 86/187 patients. Ischemic-LGE showed a specificity of 94%, a sensitivity of 89% and an accuracy of 92% in identifying significant CAD. Imaging stress test was negative in 98/105 patients without CAD, and positive in 42/82 with significant CAD, showing a specificity of 93%, a sensitivity of 51% and an accuracy of 75% in identifying CAD. Combining CMR and stress test imaging, 94 patients had ischemic-LGE pattern and/or positive stress test for ischemia; of these 81/94 had significant CAD on CA and 13 had no CAD. Among the 93 patients with both tests negative, significant CAD was found in 5/93 patients. The combination of LGE and stress respect to only LGE did not improve the diagnostic accuracy (90 vs 92% respectively).


CONCLUSIONS
LGE-CMR had high accuracy in predicting significant CAD in ischemic LV dysfunction or as a bystander in non ischemic dysfunction.
CNR, Institute of Clinical Physiology, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. Electronic address: gianluca.dibella@tiscali.it.
Gianluca
G
Di Bella
CNR, Institute of Clinical Physiology, Pisa, Italy.
Alessandro
A
Pingitore
Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Paolo
P
Piaggi
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Fausto
F
Pizzino
Fondazione Toscana G. Monasterio, CNR - Regione Toscana, Pisa, Italy.
Andrea
A
Barison
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Anna
A
Terrizzi
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Miriam
M
d'angelo
Fondazione Toscana G. Monasterio, CNR - Regione Toscana, Pisa, Italy.
Giancarlo
G
Todiere
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Salvina
S
Quattrocchi
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Scipione
S
Carerj
Fondazione Toscana G. Monasterio, CNR - Regione Toscana, Pisa, Italy.
Michele
M
Emdin
Fondazione Toscana G. Monasterio, CNR - Regione Toscana, Pisa, Italy.
Giovanni Donato
GD
Aquaro
D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D061827:Dimensional Measurement Accuracy; D005080:Exercise Test / Q000379:methods; D005260:Female; D005682:Gadolinium; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis; D055414:Myocardial Perfusion Imaging / Q000379:methods; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013223:Statistics as Topic; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology
D005682:Gadolinium
Cardiac magnetic resonance; Heart failure; Late gadolinium enhancement; Left ventricular dysfunction; Significant coronary artery disease