Cardiovascular Magnetic Resonance May Avoid Unnecessary Coronary Angiography in Patients With Unexplained Left
Louis-Marie Desroche1, Olivier Milleron2, Benjamin Safar3
1Department of Cardiology, Hôpital Bichat, Paris, France; Department of Cardiology, Hôpital Montfermeil, Montfermeil, France.
Insights
Cardiovascular magnetic resonance (CMR) imaging can effectively identify patients with reduced left ventricular ejection fraction (LVEF) who require coronary angiography (CA). Using CMR first could reduce unnecessary CA procedures by 71% without missing patients needing revascularization.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Procedures
Background:
- Patients with reduced left ventricular ejection fraction (LVEF) often undergo coronary angiography (CA) to diagnose ischemic cardiomyopathy.
- The diagnostic accuracy and clinical impact of using cardiovascular magnetic resonance (CMR) imaging as a first-line tool in this population remain to be fully elucidated.
Purpose of the Study:
- To evaluate the agreement between CA and CMR imaging in patients with unexplained reduced LVEF.
- To assess the potential consequences of utilizing CMR imaging as the initial diagnostic examination.
Main Methods:
- A retrospective analysis of 305 patients with unexplained reduced LVEF (≤45%) who underwent both CA and CMR imaging.
- Patients were categorized based on the presence or absence of myocardial ischemic scar on CMR (CMR+/CMR-) and significant coronary artery disease on CA (CA+/CA-).
Main Results:
- CMR imaging demonstrated high sensitivity (96%) and negative predictive value (99%) for detecting significant coronary artery disease.
- Revascularization was performed in 6.5% of patients, all of whom were identified as CMR positive.
- Implementing a strategy of performing CA only in CMR-positive patients could reduce the number of CA procedures by 71%.
Conclusions:
- In patients with reduced LVEF, prioritizing CMR imaging can significantly decrease the number of unnecessary coronary angiographies.
- This approach ensures that patients requiring revascularization are not missed, optimizing diagnostic pathways.
Background:
Coronary angiography (CA) is usually performed in patients with reduced left ventricular ejection fraction (LVEF) to search ischemic cardiomyopathy. Our aim was to examine the agreement between CA and cardiovascular magnetic resonance (CMR) imaging among a cohort of patients with unexplained reduced LVEF, and estimate what would have been the consequences of using CMR imaging as the first-line examination.
Methods:
Three hundred five patients with unexplained reduced LVEF of ≤45% who underwent both CA and CMR imaging were retrospectively registered. Patients were classified as CMR+ or CMR- according to presence or absence of myocardial ischemic scar, and classified CA+ or CA- according to presence or absence of significant coronary artery disease.
Results:
CMR+ (n = 89) included all 54 CA+ patients, except 2 with distal coronary artery disease in whom no revascularization was proposed. Among the 247 CA- patients, 15% were CMR+. CMR imaging had 96% sensitivity, 85% specificity, 99% negative predictive value, and 58% positive predictive value for detecting CA+ patients. Revascularization was performed in 6.5% of the patients (all CMR+). Performing CA only for CMR+ patients would have decreased the number of CAs by 71%.
Conclusions:
In reduced LVEF, performing CA only in CMR+ patients may significantly decrease the number of unnecessary CAs performed, without missing any patients requiring revascularization.
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