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CLINICAL RESEARCH: CARDIAC IMAGING

Noninvasive diagnosis of coronary artery disease in patients with heart failure and systolic dysfunction of uncertain etiology, using late gadolinium-enhanced cardiovascular magnetic resonance

Carlos J. Soriano, MD^*, Francisco Ridocci, MD, PhD, FESC^*,*, Jordi Estornell, MD, Javier Jimenez, MD^*, Vicente Martinez, MD, PhD and José A. De Velasco, MD, PhD^*

^* Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia
Unidad de TC y RM, ERESA, Valencia, Spain

Manuscript received July 13, 2004; revised manuscript received October 24, 2004, accepted November 1, 2004.

^* Reprint requests and correspondence: Dr. Francisco Ridocci, Servicio de Cardiología, Hospital General Universitario, Avda. Tres Cruces 2a, 46014 Valencia, Spain (Email: ridocci_fra{at}gva.es).

OBJECTIVES: We evaluated the feasibility of using late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) to distinguish left ventricular (LV) systolic dysfunction related or not to coronary artery disease (CAD) in patients with heart failure (HF) but without clinical suspicion of CAD as the underlying cause.

BACKGROUND: In patients with known CAD, LGE-CMR is capable of distinguishing LV systolic dysfunction related to CAD from dilated cardiomyopathy.

METHODS: Seventy-one patients with HF and LV systolic dysfunction, without a previous history of myocardial infarction, with neither Q waves nor clinical data suggesting CAD, underwent both LGE-CMR and coronary angiography.

RESULTS: Twenty-six patients (37%) had angiographically proven CAD (70% stenosis of a major epicardial vessel) (angio [+] group), and 45 (63%) had unobstructed coronary arteries (angio [–] group). Twenty-one patients in the angio (+) group (21 of 26, 81%) showed subendocardial and/or transmural enhancement, whereas only 4 (9%) of 45 in the angio (–) group showed it (p < 0.001). In 7 patients (7 of 71, 10%), we found a different pattern of mid-wall enhancement—namely, 3 of 26 patients in the angio (+) group and 4 of 45 in the angio (–) group (11% vs. 9%, p = 0.7). Mid-wall enhancement in the angio (+) group was distributed in segments other than those which had subendocardial enhancement.

CONCLUSIONS: In patients with HF and LV systolic dysfunction without clinical suspicion of CAD, LGE-CMR is an excellent tool for classifying patients in relation to the presence or absence of underlying CAD. Thus, CMR might offer a valid alternative to coronary angiography for the detection of CAD in these patients.

Abbreviations and Acronyms   CAD = coronary artery disease   CMR = cardiovascular magnetic resonance   ECG = electrocardiographic   HF = heart failure   LGE = late gadolinium enhancement/enhanced   LV = left ventricle/ventricular   MI = myocardial infarction

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