Accuracy of cardiac magnetic resonance imaging to rule out significant coronary artery disease in patients with systolic heart failure of unknown aetiology: Single-centre experience and comprehensive meta-analysis

Autor: Gilles Lemesle, François Pontana, Anju Duva Pentiah, Nicolas Lamblin, Marine Baijot, Nicolas Debry, Eric Van Belle, Marie Fertin, Guillaume Schurtz, Christopher Hurt, Cedric Delhaye, Paul Lebert, Martine Remy-Jardin, Arnaud Sudre, Christophe Bauters, Pascal de Groote, Aurélie Manchuelle, Patrizio Lancellotti
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
Contrast Media
Coronary Artery Disease
030204 cardiovascular system & hematology
Coronary Angiography
Severity of Illness Index
Ventricular Function
Left
Coronary artery disease
03 medical and health sciences
0302 clinical medicine
Cardiac magnetic resonance imaging
Predictive Value of Tests
Risk Factors
Internal medicine
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Registries
Aged
Ejection fraction
medicine.diagnostic_test
business.industry
Coronary Stenosis
Reproducibility of Results
Magnetic resonance imaging
Stroke Volume
General Medicine
Middle Aged
medicine.disease
Prognosis
Magnetic Resonance Imaging
Confidence interval
medicine.anatomical_structure
Heart failure
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Artery
Heart Failure
Systolic
Zdroj: Archives of cardiovascular diseases. 111(11)
ISSN: 1875-2128
Popis: Summary Background Coronary artery disease (CAD) is the leading cause of systolic heart failure (HF). Cardiac magnetic resonance imaging (CMR) is a non-invasive technique that detects a myocardial infarction scar as subendocardial or transmural late gadolinium enhancement (st-LGE). Aim We sought to evaluate whether a lack of st-LGE could rule out CAD in new-onset systolic HF of unknown aetiology. Methods We included 232 consecutive patients with new-onset HF and left ventricular ejection fraction ≤ 35% who underwent both coronary angiography and CMR to assess HF aetiology. CAD was defined as the presence of coronary artery stenosis ≥ 50% on a coronary angiogram. We assessed sensitivity, specificity, and positive and negative likelihood ratios (PLR and NLR) of the presence of st-LGE to detect underlying CAD. A complementary meta-analysis of 11 studies (including ours) was also performed. Results In our study, 49 (21.1%) patients had CAD. The sensitivity and specificity of the presence of st-LGE to detect CAD were 69 and 92%, respectively. PLR and NLR were 8.47 and 0.33, respectively. In the meta-analysis, 1227 patients were included, and the prevalence of CAD ranged from 19.2 to 68.3%. Sensitivity, specificity, PLR and NLR were 87% (95% confidence interval [CI] 0.80–0.92), 93% (95% CI 0.89–0.96), 12.91 (95% CI 7.70–21.64) and 0.14 (95% CI 0.09–0.22), respectively. Altogether, 55 patients presented CAD with no st-LGE; inversely, 75 patients presented st-LGE with no CAD. Conclusion With a CMR specificity of 93%, the absence of st-LGE rules out significant underlying CAD in patients with systolic HF of unknown aetiology in most cases.
Databáze: OpenAIRE
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