CT angiography with cardiac MRI: Non-invasive functional and anatomical assessment for the etiology in newly diagnosed heart failure

Hamilton-Craig, Christian, Strugnell, Wendy E., Raffel, O. Christopher, Porto, Italo, Walters, Darren L. and Slaughter, Richard E. (2012) CT angiography with cardiac MRI: Non-invasive functional and anatomical assessment for the etiology in newly diagnosed heart failure. International Journal of Cardiovascular Imaging, 28 5: 1111-1122. doi:10.1007/s10554-011-9926-y

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Author Hamilton-Craig, Christian
Strugnell, Wendy E.
Raffel, O. Christopher
Porto, Italo
Walters, Darren L.
Slaughter, Richard E.
Title CT angiography with cardiac MRI: Non-invasive functional and anatomical assessment for the etiology in newly diagnosed heart failure
Journal name International Journal of Cardiovascular Imaging   Check publisher's open access policy
ISSN 1569-5794
1875-8312
Publication date 2012
Year available 2011
Sub-type Article (original research)
DOI 10.1007/s10554-011-9926-y
Volume 28
Issue 5
Start page 1111
End page 1122
Total pages 12
Place of publication Dordrecht, Netherlands
Publisher Springer Netherlands
Collection year 2012
Language eng
Abstract Exclusion of ischemia is important in patients with newly diagnosed systolic heart failure (HF). We prospectively compared standard-of-care invasive catheter angiography (iCA) and echocardiography to a novel non-invasive strategy of both Coronary Computed Tomographic Angiography (CCTA) and Cardiovascular MRI (CMR) to determine the etiology of myocardial dysfunction Prospective data were collected from consecutive patients referred for iCA to investigate echocardiographically-confirmed new onset HF. CMR (1.5T GE) and dual source CCTA were performed within 2-7 days of iCA. Results were blinded and separately analyzed by expert readers. 426 coronary segments from 28 prospectively enrolled patients were analyzed by CCTA and quantitative iCA. The per-patient sensitivity and specificity of CCTA was 100% and 90%, respectively, negative predictive value (NPV) 100%, positive predictive value (PPV) 78%. Mean ejection fraction by CMR was 24%. Presence of ischemic-type LGE on CMR conferred a 67% sensitivity, 100% specificity, 90% NPV and 100% PPV. Combining CCTA with CMR conferred 100% specificity, 100% sensitivity, 100% PPV and 100% NPV for detection or exclusion of coronary disease. In patients with negative CCTA all invasive angiograms could have been avoided. In addition, two patients with no ischemic LGE by CMR had severe coronary disease on both CCTA and iCA, indicating global hibernation. This is a noteworthy finding in contrast to previous reports which suggested that absence of LGE rules out significant CAD. CCTA with CMR in newly-diagnosed HF enables non-invasive assessment of coronary artery disease, the severity and etiology of myocardial dysfunction and defines suitability for revascularization. Absence of ischemic-type LGE at CMR does not exclude CAD as a cause of LV dysfunction. A first-line strategy of functional and anatomic imaging with CMR and CCTA appears appropriate in newly diagnosed HF.
Keyword Cardiac CT
Cardiac magnetic resonance imaging
Heart failure
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online 26 July 2011.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
Centre for Advanced Imaging Publications
 
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Created: Fri, 09 Dec 2011, 12:46:10 EST by Matthew Lamb on behalf of School of Medicine