BACKGROUND: In patients presenting with new-onset heart failure of uncertain etiology, the role of coronary angiography (CA) is unclear. Although conventionally performed to differentiate underlying coronary artery disease from dilated cardiomyopathy, CA is associated with a risk of complications and may not detect an ischemic cause resulting from arterial recanalization or an embolic episode. In this study, we assessed the diagnostic accuracy of a cardiovascular magnetic resonance (CMR) protocol incorporating late gadolinium enhancement (LGE) and magnetic resonance CA as a noninvasive gatekeeper to CA in determining the etiology of heart failure in this subset of patients. METHODS AND RESULTS: One hundred twenty consecutive patients underwent CMR and CA. The etiology was ascribed by a consensus panel that used the results of the CMR scans. Similarly, a separate consensus group ascribed an underlying cause by using the results of CA. The diagnostic accuracy of both strategies was compared against a gold-standard panel that made a definitive judgment by reviewing all clinical data. The study was powered to show noninferiority between the 2 techniques. The sensitivity of 100%, specificity of 96%, and diagnostic accuracy of 97% for LGE-CMR were equivalent to CA (sensitivity, 93%; specificity, 96%; and diagnostic accuracy, 95%). As a gatekeeper to CA, LGE-CMR was also found to be a cheaper diagnostic strategy in a decision tree model when United Kingdom-based costs were assumed. The economic merits of this model would change, depending on the relative costs of LGE-CMR and CA in any specific healthcare system. CONCLUSION: This study showed that LGE-CMR is a safe, clinically effective, and potentially economical gatekeeper to CA in patients presenting with heart failure of uncertain etiology.
BACKGROUND: In patients presenting with new-onset heart failure of uncertain etiology, the role of coronary angiography (CA) is unclear. Although conventionally performed to differentiate underlying coronary artery disease from dilated cardiomyopathy, CA is associated with a risk of complications and may not detect an ischemic cause resulting from arterial recanalization or an embolic episode. In this study, we assessed the diagnostic accuracy of a cardiovascular magnetic resonance (CMR) protocol incorporating late gadolinium enhancement (LGE) and magnetic resonance CA as a noninvasive gatekeeper to CA in determining the etiology of heart failure in this subset of patients. METHODS AND RESULTS: One hundred twenty consecutive patients underwent CMR and CA. The etiology was ascribed by a consensus panel that used the results of the CMR scans. Similarly, a separate consensus group ascribed an underlying cause by using the results of CA. The diagnostic accuracy of both strategies was compared against a gold-standard panel that made a definitive judgment by reviewing all clinical data. The study was powered to show noninferiority between the 2 techniques. The sensitivity of 100%, specificity of 96%, and diagnostic accuracy of 97% for LGE-CMR were equivalent to CA (sensitivity, 93%; specificity, 96%; and diagnostic accuracy, 95%). As a gatekeeper to CA, LGE-CMR was also found to be a cheaper diagnostic strategy in a decision tree model when United Kingdom-based costs were assumed. The economic merits of this model would change, depending on the relative costs of LGE-CMR and CA in any specific healthcare system. CONCLUSION: This study showed that LGE-CMR is a safe, clinically effective, and potentially economical gatekeeper to CA in patients presenting with heart failure of uncertain etiology.
Authors: Pratik S Velangi; Christopher Choo; Ko-Hsuan A Chen; Felipe Kazmirczak; Prabhjot S Nijjar; Afshin Farzaneh-Far; Osama Okasha; Mehmet Akçakaya; Jonathan W Weinsaft; Chetan Shenoy Journal: Circ Cardiovasc Imaging Date: 2019-11-11 Impact factor: 7.792
Authors: Tevfik F Ismail; Wendy Strugnell; Chiara Coletti; Maša Božić-Iven; Sebastian Weingärtner; Kerstin Hammernik; Teresa Correia; Thomas Küstner Journal: Front Cardiovasc Med Date: 2022-03-03
Authors: Eugene Won; Robert Donnino; Monvadi B Srichai; Steven P Sedlis; Frederick Feit; Linda Rolnitzky; Louis H Miller; Sohah N Iqbal; Leon Axel; Brian Nguyen; James Slater; Binita Shah Journal: Am J Cardiol Date: 2015-07-16 Impact factor: 2.778
Authors: Sophie I Mavrogeni; George Markousis-Mavrogenis; David Heutemann; Kees van Wijk; Hans J Reiber; Genovefa Kolovou Journal: World J Methodol Date: 2015-09-26
Authors: Tomas Vita; Christoph Gräni; Siddique A Abbasi; Tomas G Neilan; Ethan Rowin; Kyoichi Kaneko; Otavio Coelho-Filho; Eri Watanabe; Francois-Pierre Mongeon; Hoshang Farhad; Carlos Henrique Rassi; Yuna L Choi; Kathleen Cheng; Michael M Givertz; Ron Blankstein; Michael Steigner; Ayaz Aghayev; Michael Jerosch-Herold; Raymond Y Kwong Journal: JACC Cardiovasc Imaging Date: 2018-11-15