Combined coronary and late-enhanced multidetector-computed tomography for delineation of the etiology of left ventricular dysfunction: comparison with coronary angiography and contrast-enhanced cardiac magnetic resonance imaging.

Le Polain De Waroux, Jean-Benoît;Pouleur, Anne-Catherine;Goffinet, Céline;Pasquet, Agnes;Gerber, Bernhard;et.al.
(2008) European Heart Journal (English Edition) — Vol. 29, n° 20, p. 2544-2551 (2008)

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AIMS: To evaluate whether comprehensive evaluation of coronary anatomy and delayed enhancement (DE) by multidetector-computed tomography (MDCT) would allow determination of etiology of left ventricular dysfunction (LVD) as compared with coronary angiography (CA) and DE-magnetic resonance (CMR). METHODS AND RESULTS: Seventy-one consecutive patients (50 males, 59 +/- 16 years) with LVD (ejection fraction: 26 +/- 11%) of unknown etiology underwent MDCT, LGE (late Gd-DTPA-enhanced)-CMR and CA. Patients were classified into four groups according to coronary artery disease (CAD) by CA and LGE-CMR patterns. Patients (n = 24) with CAD and transmural or sub-endocardial DE by CMR were considered having definite ischaemic LVD (group 1). Patients (n = 36) without CAD by CA and with no/atypical LGE-CMR were considered non-ischaemic LVD (group 2). Further we identified four patients with transmural DE but no CAD (group 3) and seven patients with CAD but no DE (group 4). On per-patient basis, combined coronary and DE-MDCT had excellent agreement (kappa = 0.89; P < 0.001) with CA/LGE-CMR to classify patients into the same four groups. Sensitivity, specificity and accuracy of MDCT were 97, 92 and 94%, respectively for detecting patients with definite (group 1) or likely (groups 3 and 4) ischaemic LVD. CONCLUSION: Combined coronary and DE-MDCT can accurately differentiate ischaemic vs. non-ischaemic etiology of LVD.
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Le Polain De Waroux, J.-B., Pouleur, A.-C., Goffinet, C., Pasquet, A., Vanoverschelde, J.-L., & Gerber, B. (2008). Combined coronary and late-enhanced multidetector-computed tomography for delineation of the etiology of left ventricular dysfunction: comparison with coronary angiography and contrast-enhanced cardiac magnetic resonance imaging. European Heart Journal (English Edition), 29(20), 2544-2551. https://doi.org/10.1093/eurheartj/ehn381 (Original work published 2008)