Abstract
Background: On echocardiography, a pattern of left ventricular dysfunction with significant regional variability is suggestive of ischaemic heart disease (IHD). Cardiac magnetic resonance (CMR) can demonstrate infarction as subendocardial late gadolinium enhancement (sLGE) and may differentiate IHD-related left ventricular dysfunction from a dilated cardiomyopathy with incidental coronary artery disease (CAD).
Methods: Patients being considered for defibrillator implantation underwent CMR within 30 days of echocardiography. On echocardiography, expert readers judged whether the pattern of left ventricular dysfunction was global or had significant regional variability (segmental) to suggest IHD. The presence of CAD was ascertained from medical records based on at least one epicardial coronary stenosis of >70% severity or past coronary revascularisation.
Results: Fifty-two patients (age 62±15 years, 81% male) were studied. The mean left ventricular ejection fraction on CMR was 35±14%. A segmental pattern of left ventricular dysfunction on echocardiography had a sensitivity of 20/26 (77%) and a specificity of 21/26 (81%) for the presence of CAD. Using CMR as a reference standard, a segmental pattern of dysfunction had a sensitivity of 19/23 (83%) and a specificity of 23/29 (79%) for the presence of sLGE. All patients with sLGE had CAD, however three patients without sLGE had significant epicardial coronary stenoses.
Conclusions: A segmental pattern of left ventricular dysfunction on echocardiography has reasonable predictive value for identifying myocardial infarction on CMR. However a global pattern of dysfunction does not exclude IHD regardless of whether infarction on CMR or angiography is used as the reference standard.
Methods: Patients being considered for defibrillator implantation underwent CMR within 30 days of echocardiography. On echocardiography, expert readers judged whether the pattern of left ventricular dysfunction was global or had significant regional variability (segmental) to suggest IHD. The presence of CAD was ascertained from medical records based on at least one epicardial coronary stenosis of >70% severity or past coronary revascularisation.
Results: Fifty-two patients (age 62±15 years, 81% male) were studied. The mean left ventricular ejection fraction on CMR was 35±14%. A segmental pattern of left ventricular dysfunction on echocardiography had a sensitivity of 20/26 (77%) and a specificity of 21/26 (81%) for the presence of CAD. Using CMR as a reference standard, a segmental pattern of dysfunction had a sensitivity of 19/23 (83%) and a specificity of 23/29 (79%) for the presence of sLGE. All patients with sLGE had CAD, however three patients without sLGE had significant epicardial coronary stenoses.
Conclusions: A segmental pattern of left ventricular dysfunction on echocardiography has reasonable predictive value for identifying myocardial infarction on CMR. However a global pattern of dysfunction does not exclude IHD regardless of whether infarction on CMR or angiography is used as the reference standard.
| Original language | English |
|---|---|
| Article number | 555 |
| Pages (from-to) | S229 |
| Number of pages | 1 |
| Journal | Heart, Lung and Circulation |
| Volume | 21 |
| Issue number | Supplement 1 |
| DOIs | |
| Publication status | Published - 27 Jul 2012 |