Cargando…
Does stress perfusion imaging improve the diagnostic accuracy of late gadolinium enhanced cardiac magnetic resonance for establishing the etiology of heart failure?
BACKGROUND: Late gadolinium enhanced cardiovascular magnetic resonance (LGE-CMR) has excellent specificity, sensitivity and diagnostic accuracy for differentiating between ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NICM). CMR first-pass myocardial perfusion imaging (perfu...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385076/ https://www.ncbi.nlm.nih.gov/pubmed/28390413 http://dx.doi.org/10.1186/s12872-017-0529-y |
_version_ | 1782520539894513664 |
---|---|
author | Gulsin, Gaurav S. Shetye, Abishek Khoo, Jeffrey Swarbrick, Daniel J. Levelt, Eylem Lai, Florence Y. Squire, Iain B. Arnold, Jayanth R. McCann, Gerry P. |
author_facet | Gulsin, Gaurav S. Shetye, Abishek Khoo, Jeffrey Swarbrick, Daniel J. Levelt, Eylem Lai, Florence Y. Squire, Iain B. Arnold, Jayanth R. McCann, Gerry P. |
author_sort | Gulsin, Gaurav S. |
collection | PubMed |
description | BACKGROUND: Late gadolinium enhanced cardiovascular magnetic resonance (LGE-CMR) has excellent specificity, sensitivity and diagnostic accuracy for differentiating between ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NICM). CMR first-pass myocardial perfusion imaging (perfusion-CMR) may also play role in distinguishing heart failure of ischemic and non-ischemic origins, although the utility of additional of stress perfusion imaging in such patients is unclear. The aim of this retrospective study was to assess whether the addition of adenosine stress perfusion imaging to LGE-CMR is of incremental value for differentiating ICM and NICM in patients with severe left ventricular systolic dysfunction (LVSD) of uncertain etiology. METHODS: We retrospectively identified 100 consecutive adult patients (median age 69 years (IQR 59–73)) with severe LVSD (mean LV EF 26.6 ± 7.0%) referred for perfusion-CMR to establish the underlying etiology of heart failure. The cause of heart failure was first determined on examination of CMR cine and LGE images in isolation. Subsequent examination of complete adenosine stress perfusion-CMR studies (cine, LGE and perfusion images) was performed to identify whether this altered the initial diagnosis. RESULTS: On LGE-CMR, 38 patients were diagnosed with ICM, 46 with NICM and 16 with dual pathology. With perfusion-CMR, there were 39 ICM, 44 NICM and 17 dual pathology diagnoses. There was excellent agreement in diagnoses between LGE-CMR and perfusion-CMR (κ 0.968, p<0.001). The addition of adenosine stress perfusion images to LGE-CMR altered the diagnosis in only two of the 100 patients. CONCLUSION: The addition of adenosine stress perfusion-CMR to cine and LGE-CMR provides minimal incremental diagnostic yield for determining the etiology of heart failure in patients with severe LVSD. |
format | Online Article Text |
id | pubmed-5385076 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-53850762017-04-12 Does stress perfusion imaging improve the diagnostic accuracy of late gadolinium enhanced cardiac magnetic resonance for establishing the etiology of heart failure? Gulsin, Gaurav S. Shetye, Abishek Khoo, Jeffrey Swarbrick, Daniel J. Levelt, Eylem Lai, Florence Y. Squire, Iain B. Arnold, Jayanth R. McCann, Gerry P. BMC Cardiovasc Disord Research Article BACKGROUND: Late gadolinium enhanced cardiovascular magnetic resonance (LGE-CMR) has excellent specificity, sensitivity and diagnostic accuracy for differentiating between ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NICM). CMR first-pass myocardial perfusion imaging (perfusion-CMR) may also play role in distinguishing heart failure of ischemic and non-ischemic origins, although the utility of additional of stress perfusion imaging in such patients is unclear. The aim of this retrospective study was to assess whether the addition of adenosine stress perfusion imaging to LGE-CMR is of incremental value for differentiating ICM and NICM in patients with severe left ventricular systolic dysfunction (LVSD) of uncertain etiology. METHODS: We retrospectively identified 100 consecutive adult patients (median age 69 years (IQR 59–73)) with severe LVSD (mean LV EF 26.6 ± 7.0%) referred for perfusion-CMR to establish the underlying etiology of heart failure. The cause of heart failure was first determined on examination of CMR cine and LGE images in isolation. Subsequent examination of complete adenosine stress perfusion-CMR studies (cine, LGE and perfusion images) was performed to identify whether this altered the initial diagnosis. RESULTS: On LGE-CMR, 38 patients were diagnosed with ICM, 46 with NICM and 16 with dual pathology. With perfusion-CMR, there were 39 ICM, 44 NICM and 17 dual pathology diagnoses. There was excellent agreement in diagnoses between LGE-CMR and perfusion-CMR (κ 0.968, p<0.001). The addition of adenosine stress perfusion images to LGE-CMR altered the diagnosis in only two of the 100 patients. CONCLUSION: The addition of adenosine stress perfusion-CMR to cine and LGE-CMR provides minimal incremental diagnostic yield for determining the etiology of heart failure in patients with severe LVSD. BioMed Central 2017-04-08 /pmc/articles/PMC5385076/ /pubmed/28390413 http://dx.doi.org/10.1186/s12872-017-0529-y Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Gulsin, Gaurav S. Shetye, Abishek Khoo, Jeffrey Swarbrick, Daniel J. Levelt, Eylem Lai, Florence Y. Squire, Iain B. Arnold, Jayanth R. McCann, Gerry P. Does stress perfusion imaging improve the diagnostic accuracy of late gadolinium enhanced cardiac magnetic resonance for establishing the etiology of heart failure? |
title | Does stress perfusion imaging improve the diagnostic accuracy of late gadolinium enhanced cardiac magnetic resonance for establishing the etiology of heart failure? |
title_full | Does stress perfusion imaging improve the diagnostic accuracy of late gadolinium enhanced cardiac magnetic resonance for establishing the etiology of heart failure? |
title_fullStr | Does stress perfusion imaging improve the diagnostic accuracy of late gadolinium enhanced cardiac magnetic resonance for establishing the etiology of heart failure? |
title_full_unstemmed | Does stress perfusion imaging improve the diagnostic accuracy of late gadolinium enhanced cardiac magnetic resonance for establishing the etiology of heart failure? |
title_short | Does stress perfusion imaging improve the diagnostic accuracy of late gadolinium enhanced cardiac magnetic resonance for establishing the etiology of heart failure? |
title_sort | does stress perfusion imaging improve the diagnostic accuracy of late gadolinium enhanced cardiac magnetic resonance for establishing the etiology of heart failure? |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385076/ https://www.ncbi.nlm.nih.gov/pubmed/28390413 http://dx.doi.org/10.1186/s12872-017-0529-y |
work_keys_str_mv | AT gulsingauravs doesstressperfusionimagingimprovethediagnosticaccuracyoflategadoliniumenhancedcardiacmagneticresonanceforestablishingtheetiologyofheartfailure AT shetyeabishek doesstressperfusionimagingimprovethediagnosticaccuracyoflategadoliniumenhancedcardiacmagneticresonanceforestablishingtheetiologyofheartfailure AT khoojeffrey doesstressperfusionimagingimprovethediagnosticaccuracyoflategadoliniumenhancedcardiacmagneticresonanceforestablishingtheetiologyofheartfailure AT swarbrickdanielj doesstressperfusionimagingimprovethediagnosticaccuracyoflategadoliniumenhancedcardiacmagneticresonanceforestablishingtheetiologyofheartfailure AT levelteylem doesstressperfusionimagingimprovethediagnosticaccuracyoflategadoliniumenhancedcardiacmagneticresonanceforestablishingtheetiologyofheartfailure AT laiflorencey doesstressperfusionimagingimprovethediagnosticaccuracyoflategadoliniumenhancedcardiacmagneticresonanceforestablishingtheetiologyofheartfailure AT squireiainb doesstressperfusionimagingimprovethediagnosticaccuracyoflategadoliniumenhancedcardiacmagneticresonanceforestablishingtheetiologyofheartfailure AT arnoldjayanthr doesstressperfusionimagingimprovethediagnosticaccuracyoflategadoliniumenhancedcardiacmagneticresonanceforestablishingtheetiologyofheartfailure AT mccanngerryp doesstressperfusionimagingimprovethediagnosticaccuracyoflategadoliniumenhancedcardiacmagneticresonanceforestablishingtheetiologyofheartfailure |