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

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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.

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Abbreviations

CCTA:

Cardiac computed tomographic angiography

CMR:

Cardiovascular magnetic resonance.

HF:

Heart failure

LGE:

Late gadolinium enhancement

iCA:

Invasive coronary angiography

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Acknowledgments

Dr Mark Hansen and Dr Adrian Khoo for assistance with CT data analysis, and to the staff at the Centre for Cardiovascular Imaging, Prince Charles Hospital.

Conflict of interest

Dr Hamilton-Craig is supported by grants from the National Heart Foundation of Australia, the Queensland International Fellowship, and the University of Washington Trans-Pacific Fellowship. The authors report no conflicts of interest.

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Authors and Affiliations

  1. University of Queensland, School of Medicine, Herston Road, Brisbane, QLD, Australia

    Christian Hamilton-Craig

  2. Department of Radiology, University of Washington, Seattle, WA, USA

    Christian Hamilton-Craig

  3. The Prince Charles Hospital, Queensland University of Technology, Brisbane, QLD, Australia

    Wendy E. Strugnell, O. Christopher Raffel, Darren L. Walters & Richard E. Slaughter

  4. Catholic University of the Sacred Heart, Rome, Italy

    Italo Porto

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  1. Christian Hamilton-Craig
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  2. Wendy E. Strugnell
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Correspondence to Christian Hamilton-Craig.

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Hamilton-Craig, C., Strugnell, W.E., Raffel, O.C. et al. CT angiography with cardiac MRI: non-invasive functional and anatomical assessment for the etiology in newly diagnosed heart failure. Int J Cardiovasc Imaging 28, 1111–1122 (2012). https://doi.org/10.1007/s10554-011-9926-y

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