Abstract 1769: Multidetector Computed Tomography allows accurate non-invasive Diagnosis of Etiology of Heart failure as compared with Coronary Angiography and contrast-enhanced MRI
Background: The distinction of ischemic vs. non-ischemic origin is essential for prognosis and treatment of patients (pts) with congestive heart failure (CHF). To determine etiology, pts typically undergo invasive coronary angiography (CA). Additional information can be obtained by detecting necrosis or fibrosis on delayed enhanced (DE) magnetic resonance (cMR). Recently, we and others have demonstrated that detection of myocardial necrosis is also feasible by multidetector CT (MDCT) at the time of non-invasive coronary imaging. We therefore evaluated whether such a combined and comprehensive evaluation of coronary anatomy and infarct characterization by MDCT might be useful for determining the etiology of CHF.
Methods: Sixty-one consecutive pts (44 males, 60 ± 16 years) with CHF (mean ejection fraction: 26 ± 11%) of undetermined etiology underwent MDCT, DE-MR and CA. Presence of coronary artery disease (CAD) and patterns of DE on MDCT were compared to CA and DE-MR.
Results: According to CA, 27 pts (44%) had significant CAD (>50% stenosis in at least one major coronary artery). DE-cMR demonstrated transmural or subendocardial DE in 21 of these 27 pts. These 21 pts were considered to have definite ischemic CHF (group 1). Among the 34 pts without CAD on CA, 23 had no DE on cMR, while 7 (11%) presented midventricular or sub-epicardial DE. These 30 pts were considered to have definite non-ischemic CHF (group 2). Four pts had transmural DE but no CAD and were considered to have probable ischemic CHF (group 3). Finally, 6 pts with CAD on CA, but without DE on cMR were considered to have probable non-ischemic CHF (group 4). Pts were also classified into the same 4 groups using coronary and DE-MDCT. On a per patient basis, agreement between coronary and DE-MDCT and CA/DE-cMR for the diagnosis of patients was excellent (κ=0.87; p<0.001). Coronary and DE-MDCT had 96% sensitivity, 92% specificity and 93% accuracy for detecting definite (group 1) or probable (group 3) ischemic CHF as compared to DE-cMR and CA.
Conclusion: Combined coronary and DE-MDCT allows for the accurate differentiation of ischemic vs non ischemic etiology of CHF as compared to CA and DE-cMR. Using this single test is however cheaper and faster than combined use of DE-cMR and CA for establishing etiology of CHF.