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

  • Christian Hamilton-Craig
  • Wendy E. Strugnell
  • O. Christopher Raffel
  • Italo Porto
  • Darren L. Walters
  • Richard E. Slaughter
Original Paper

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.

Keywords

Heart failure Cardiac CT Cardiac magnetic resonance imaging 

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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Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Christian Hamilton-Craig
    • 1
    • 2
  • Wendy E. Strugnell
    • 3
  • O. Christopher Raffel
    • 3
  • Italo Porto
    • 4
  • Darren L. Walters
    • 3
  • Richard E. Slaughter
    • 3
  1. 1.University of Queensland, School of MedicineBrisbaneAustralia
  2. 2.Department of RadiologyUniversity of WashingtonSeattleUSA
  3. 3.The Prince Charles HospitalQueensland University of TechnologyBrisbaneAustralia
  4. 4.Catholic University of the Sacred HeartRomeItaly

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