Document Detail

Role of cardiovascular magnetic resonance as a gatekeeper to invasive coronary angiography in patients presenting with heart failure of unknown etiology.
MedLine Citation:
PMID:  21900085     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In patients presenting with new-onset heart failure of uncertain etiology, the role of coronary angiography (CA) is unclear. Although conventionally performed to differentiate underlying coronary artery disease from dilated cardiomyopathy, CA is associated with a risk of complications and may not detect an ischemic cause resulting from arterial recanalization or an embolic episode. In this study, we assessed the diagnostic accuracy of a cardiovascular magnetic resonance (CMR) protocol incorporating late gadolinium enhancement (LGE) and magnetic resonance CA as a noninvasive gatekeeper to CA in determining the etiology of heart failure in this subset of patients.
METHODS AND RESULTS: One hundred twenty consecutive patients underwent CMR and CA. The etiology was ascribed by a consensus panel that used the results of the CMR scans. Similarly, a separate consensus group ascribed an underlying cause by using the results of CA. The diagnostic accuracy of both strategies was compared against a gold-standard panel that made a definitive judgment by reviewing all clinical data. The study was powered to show noninferiority between the 2 techniques. The sensitivity of 100%, specificity of 96%, and diagnostic accuracy of 97% for LGE-CMR were equivalent to CA (sensitivity, 93%; specificity, 96%; and diagnostic accuracy, 95%). As a gatekeeper to CA, LGE-CMR was also found to be a cheaper diagnostic strategy in a decision tree model when United Kingdom-based costs were assumed. The economic merits of this model would change, depending on the relative costs of LGE-CMR and CA in any specific healthcare system.
CONCLUSION: This study showed that LGE-CMR is a safe, clinically effective, and potentially economical gatekeeper to CA in patients presenting with heart failure of uncertain etiology.
Ravi G Assomull; Carl Shakespeare; Paul R Kalra; Guy Lloyd; Ankur Gulati; Julian Strange; William M Bradlow; Jonathan Lyne; Jennifer Keegan; Philip Poole-Wilson; Martin R Cowie; Dudley J Pennell; Sanjay K Prasad
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Validation Studies     Date:  2011-09-06
Journal Detail:
Title:  Circulation     Volume:  124     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-20     Completed Date:  2011-11-15     Revised Date:  2012-08-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1351-60     Citation Subset:  AIM; IM    
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.
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MeSH Terms
Cardiac Imaging Techniques / economics,  standards*,  statistics & numerical data
Coronary Angiography* / economics
Decision Trees
Follow-Up Studies
Gadolinium / diagnostic use
Great Britain
Health Care Costs
Heart Failure / diagnosis*,  economics,  etiology*
Magnetic Resonance Imaging / economics,  standards*,  statistics & numerical data
Middle Aged
Observer Variation
Referral and Consultation / economics,  standards,  statistics & numerical data
Reproducibility of Results
Sensitivity and Specificity
Grant Support
//British Heart Foundation
Reg. No./Substance:
Comment In:
Circulation. 2012 Jun 19;125(24):e1041; author reply e1042   [PMID:  22711673 ]

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