Usefulness of late gadolinium enhancement MRI combined with stress imaging in predictive significant coronary stenosis in new-diagnosed left ventricular dysfunction

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• 作者：Gianluca Di Bella^a ; ^b ; ¹ ; ^{gianluca.dibella@tiscali.it" class="auth_mail" title="E-mail the corresponding author} ; Alessandro Pingitore^a ; Paolo Piaggi^c ; Fausto Pizzino^b ; Andrea Barison^d ; Anna Terrizzi^b ; Miriam d'angelo^b ; Giancarlo Todiere^d ; Salvina Quattrocchi^b ; Scipione Carerj^b ; Michele Emdin^d ; Giovanni Donato Aquaro^d ; ¹
• 关键词：Cardiac magnetic resonance ; Left ventricular dysfunction ; Heart failure ; Significant coronary artery disease ; Late gadolinium enhancement
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 December 2016
• 年：2016
• 卷：224
• 期：Complete
• 页码：337-342
• 全文大小：699 K

文摘

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 ± 17 years) 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).

Conclusion

LGE-CMR had high accuracy in predicting significant CAD in ischemic LV dysfunction or as a bystander in non ischemic dysfunction.