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Publications

Journal Article Ahead of print 3 citations

PubMed: 40147871 DOI: 10.1136/heartjnl-2024-325419

Diagnostic accuracy of late gadolinium enhancement cardiac MRI for coronary artery disease in patients with reduced left ventricular ejection fraction.

Heart

Authors: Louis-Marie Desroche, Arthur Darmon, Yoan Lavie-Badie, Damien Mandry, Gregory Ducrocq, Thiziri Si-Moussi, Isabelle Durand-Zaleski, Damien Millischer, Olivier Milleron, Olivier Huttin, Mathieu Valla, Lionel Mangin, Bruno Farah, Christelle Diakov, Damien Logeart, Benjamin Safar, Jean-Yves Travers, Jules Mesnier, Alexandra Vappereau, Toni Alfaiate, Charles Burdet, Guillaume Jondeau

Affiliations

  • Cardiology Department, La Réunion University Hospital, Saint-Denis, France.
  • CIC-EC INSERM1410, La Réunion University Hospital, Saint-Denis, France.
  • Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
  • Cardiology Department, Toulouse University Hospital, Toulouse, France.
  • Radiology Department, Nancy University Hospital, Nancy, France.
  • Bichat - Claude-Bernard Hospital Cardiology Service, Paris, France.
  • INSERM U1148 LVTS, Bichat Hospital, Paris, France.
  • French Alliance for Cardiovascular Trials (FACT), Paris, France.
  • Paris University, Paris, France.
  • Cardiology Department, La Réunion University Hospital, Saint-Denis, France.
  • Clinical Research Unit-Health Economics (URC-Eco), APHP, Paris, France.
  • INSERM 1153 CRESS Research Center in Epidemiology and Statistics, Sorbonne Paris Cité, Paris, France.
  • Cardiology Department, Montfermeil Hospital, Montfermeil, France.
  • Cardiology Department, Nancy University Hospital, Nancy, France.
  • INSERM U1116, Nancy University Hospital, Nancy, France.
  • Lorraine University, Nancy, France.
  • CIC-1433, Nancy Hospital, Nancy, France.
  • Cardiology Department, Mercy Hospital, CHR Metz-Thionville, Metz, France.
  • Cardiology Department, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France.
  • Cardiology Department, Pasteur Clinic, Toulouse, France.
  • Cardiology Department, Institut Mutualiste Montsouris, Paris, France.
  • Cardiology, Universitary Hospital Saint-Louis - Lariboisière - Fernand-Widal, AP-HP, Paris, France.
  • Hopital Montfermeil, Montfermeil, France.
  • Radiology Department, La Réunion University Hospital, Saint-Denis, France.
  • Department of Epidemiology, Biostatistics and Clinical Research, Bichat Hospital, Paris, France.
  • CIC 1425, Bichat Hospital, Paris, France.

Abstract

BACKGROUND

Identifying significant coronary artery disease (CAD) in patients with reduced left ventricular ejection fraction (rLVEF) is essential for guiding therapeutic decisions, including medical management, device implantation and potential revascularisation. Prior studies suggested that rest cardiac MRI (CMR) with late gadolinium enhancement (LGE) could reliably detect significant CAD. We aimed to evaluate the diagnostic accuracy of rest LGE-CMR for predicting significant CAD in rLVEF patients.

METHODS

In this prospective, multicentre cohort study across 10 centres, adults with new-onset rLVEF≤45% without obvious cause were included. All patients underwent rest CMR and coronary angiography. Independent, blinded committees reviewed images. Significant CAD was defined as ≥70% stenosis in major coronary arteries. Ischaemic scars were identified on CMR as subendocardial LGE. The primary outcome was the sensitivity of CMR in detecting significant CAD.

RESULTS

Among 380 patients (median age 63 years, 68% male), significant CAD was present in 49 (13%). CMR identified ischaemic scars in 106 (28%). The sensitivity of CMR for detecting significant CAD was 57% (95% CI: 43% to 71%), specificity 76% (95% CI: 72% to 81%), positive predictive value 26% (95% CI: 18% to 35%) and negative predictive value 92% (95% CI: 89% to 95%). A CMR-first strategy would have missed 43% of significant CAD cases, many requiring revascularisation (86% of missed cases).

CONCLUSIONS

In this large, prospective multicentre study with independent image review, rest LGE-CMR demonstrated limited sensitivity for detecting significant CAD in patients with rLVEF. Relying solely on CMR could lead to missed diagnoses and undertreatment. CMR should be integrated with other diagnostic tools to optimise care in this population.

TRIAL REGISTRATION NUMBER

NCT03231189.

MeSH

Heart Diseases, Coronary Artery Disease, Cicatrix, Predictive Value Of Tests, Arteries