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Updated: Sep 15, 2025

Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
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Cardiac Magnetic Resonance Imaging vs Coronary Angiography as Primary Strategy in Newly Diagnosed Heart Failure

Gülmisal Güder1, Theresa Reiter2, Wolfgang R Bauer1

  • 1Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany; Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.

JACC. Heart Failure
|July 13, 2025
PubMed

Insights

A cardiac MRI-first strategy can diagnose ischemic cardiomyopathy with similar sensitivity to invasive coronary angiography, potentially reducing unnecessary procedures for heart failure patients.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Heart Failure Research

Background:

  • New-onset heart failure with reduced ejection fraction (HFrEF) necessitates etiological diagnosis.
  • Cardiac magnetic resonance (CMR) can identify causes of HFrEF, but invasive coronary angiography (CATH) is standard for diagnosing ischemic cardiomyopathy (ICM).

Purpose of the Study:

  • To compare a CMR-first strategy versus a CATH-first strategy for diagnosing ICM in new-onset HFrEF.
  • To assess the potential reduction in invasive procedures using a CMR-first approach.

Main Methods:

  • A multicenter, randomized trial involving 229 adults with new-onset HFrEF.
  • Patients were assigned to undergo either CMR or CATH as the initial diagnostic modality, followed by the other.
  • Expert panels evaluated both modalities blinded to results; the cardiologist-in-charge served as the reference standard.

Main Results:

  • CATH was deemed sufficient for ICM diagnosis in 100% of cases, compared to 80% for CMR (P < 0.001).
  • Both modalities demonstrated high sensitivity for ICM (CATH 91%, CMR 90%), but CMR had lower specificity (74% vs. 98% for CATH).
  • A CMR-first strategy could have potentially avoided 45-48% of CATH procedures.

Conclusions:

  • While CATH is superior for ICM diagnosis, CMR offers comparable sensitivity and can significantly decrease the need for invasive angiography.
  • A CMR-first strategy may reduce invasive procedures without compromising the detection of critical coronary interventions.
Abstract

Keywords:
HFrEFcardiac magnetic resonanceheart failure etiologyischemic cardiomyopathy

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