Reliable exclusion of prognostically significant coronary disease in left ventricular dysfunction by cardiac MRI.
OBJECTIVE
To assess the ability of cardiac magnetic resonance (CMR) to exclude prognostically significant coronary artery disease (CAD) in patients with left ventricular systolic dysfunction (LVSD).


METHODS
A cohort of patients who underwent both X-ray angiography and CMR since 2006 was reviewed retrospectively. Records of those with European criteria for LVSD (left ventricular ejection fraction [LVEF] <50% or LV end-diastolic volume index [LVEDVI] ≥97 ml/m2) on CMR or transthoracic echo were analysed. The presence and extent of subendocardial late gadolinium enhancement (LGE) was recorded with the 17-segment model. The degree of coronary stenosis at X-ray angiography was assessed visually and significant disease defined as stenosis of the LMS ≥50%, or proximal left anterior descending ≥75%, or ≥70% in two main coronary vessels.


RESULTS
One hundred and sixteen patients were included. The mean age was 64 years and 78% were male. The mean LVEF was 40%. The prevalence of prognostic CAD was 47%. The presence of subendocardial LGE detected prognostically significant CAD with a sensitivity of 100% (95% CI: 94-100%) with no false-negative results.


CONCLUSIONS
The absence of subendocardial LGE on CMR reliably excludes prognostic CAD in patients with LVSD.
Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, County Durham, UK; School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees, UK. Electronic address: acmthompson@doctors.org.uk.
A C M
AC
Thompson
Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, County Durham, UK.
J G
JG
Crilley
School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees, UK.
D W
DW
Wilson
School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees, UK.
A P S
AP
Hungin
Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, County Durham, UK; School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees, UK.
A
A
Fuat
Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, County Durham, UK; School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees, UK.
J J M
JJ
Murphy
D000368:Aged; D015984:Causality; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*