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CMR imaging assessing viability in patients with chronic ventricular dysfunction due to coronary artery disease: a

Jorge Romero1, Xiaonan Xue, Waddy Gonzalez

  • 1Division of Cardiology and Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467-2400, USA.

JACC. Cardiovascular Imaging
|May 19, 2012
PubMed

Insights

Contrast delayed enhancement (DE) cardiac magnetic resonance (CMR) offers the highest sensitivity for assessing myocardial viability, while low-dose dobutamine (LDD) CMR provides the best specificity. Integrating DE and LDD CMR enhances diagnostic accuracy for patients with left ventricular dysfunction.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Diagnostic Accuracy

Background:

  • Cardiac magnetic resonance (CMR) is explored for assessing myocardial viability.
  • Optimal CMR strategy for revascularization candidates remains undetermined.
  • DE CMR excels at scar identification; LDD CMR identifies contractile reserve.

Purpose of the Study:

  • Compare diagnostic accuracy of three CMR techniques for myocardial viability.
  • Evaluate end-diastolic wall thickness (EDWT), low-dose dobutamine (LDD), and contrast delayed enhancement (DE) in chronic left ventricular dysfunction.
  • Assess CMR's role in patients with coronary artery disease.

Main Methods:

  • Systematic review of prospective trials in MEDLINE, Cochrane, and Embase.
  • Meta-analysis of diagnostic test accuracy using bivariate analysis.
  • Included studies assessed myocardial viability in chronic LV dysfunction via CMR.

Main Results:

  • DE CMR demonstrated highest sensitivity (95%) and negative predictive value (NPV) (90%).
  • LDD CMR showed highest specificity (91%) and positive predictive value (PPV) (93%).
  • EDWT CMR performed intermediately, with LDD CMR having the lowest sensitivity/NPV and EDWT the lowest specificity/PPV.

Conclusions:

  • DE CMR is superior for sensitivity and NPV in predicting contractile function post-revascularization.
  • LDD CMR excels in specificity and PPV.
  • Combining DE and LDD CMR techniques is recommended for improved diagnostic accuracy.
Abstract

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