Cardiovascular Magnetic Resonance may avoid unnecessary coronary angiography in patients with unexplained left ventricular systolic dysfunction: a retrospective diagnostic pilot study.

Desroche, Louis-Marie; Milleron, Olivier; Safar, Benjamin; Ou, Phalla; Garbarz, Eric; Lavie-Badie, Yoan; Abtan, Jérémie; Millischer, Damien; Pathak, Atul; Durand-Zaleski, Isabelle; Cattan, Simon; Ronchard, Thibault; Jondeau, Guillaume

BACKGROUNDS Coronary angiography(CA) is usually performed in patients with reduced left ventricular ejection fraction(LVEF) to SEARCH: ischemic cardiomyopathy. Our aim was to examine the agreement between CA and cardiovascular magnetic resonance(CMR) among a cohort of patients with unexplained reduced LVEF, and estimate what would have been the consequences of using CMR as the first-line exam. METHODS Three hundred and five patients with unexplained reduced LVEF≤ 45% who underwent both CA and CMR were retrospectively registered. Patients were classified as CMR+ or CMR- according to presence or absence of myocardial ischemic scar, and classified CA+ or CA- according to presence or absence of significant coronary artery disease(CAD). RESULTS CMR+(n=89) included all 54CA+ patients, except 2 with distal CAD in whom no revascularization was proposed. Among the 247CA- patients, 15% were CMR+. CMR had 96% sensitivity, 85% specificity, 99% negative predictive value, and 58% positive predictive value for detecting CA+ patients. Revascularization was performed in 6.5% of the patients (all CMR+). Performing CA only for CMR+ patients would have decreased the number of CAs by 71%. CONCLUSIONS In reduced LVEF, performing CA only in CMR+ patients may significantly reduce the number of unnecessary CAs performed, without missing any patients requiring revascularization.