Abstract 17458: Which is Superior for the Diagnosis of Underlying Etiology in Heart Failure, Cardiac Magnetic Resonance or Endomyocardial Biopsy?
Background: Cardiac magnetic resonance (CMR) is a noninvasive imaging technique that is rapidly emerging and increasingly used for the patients with heart failure, however, diagnostic performance of CMR has not been directly compared with other diagnostic modalities. We sought to evaluate the diagnostic impact of CMR for heart failure patients in comparison with endomyocardial biopsy (EMB).
Methods: We studied 137 patients with cardiomyopathy who underwent both CMR and right ventricular EMB. CMR was performed using both cine ventricular function and late gadolinium enhancement (LGE). Both CMR and histology were reviewed by an experienced cardiac radiologist and pathologists, respectively, blinded to all other clinical data. The expert team of cardiologists at our center made final diagnosis with all clinical data based on World Health Organization – International Society and Federation of Cardiology criteria. We evaluated both sensitivity and specificity for CMR or EMB diagnosis compared with the gold-standard final diagnosis.
Results: The sensitivity and specificity of CMR and EMB were shown in Table. CMR had a tendency to yield better sensitivity in cardiac sarcoidosis and hypertensive heart disease (HHD) and better specificity in dilated cardiomyopathy (DCM) compared with EMB. There were no differences in accurate diagnostic rate of CMR and EMB in hypertrophic cardiomyopathy (HCM) in total; however, CMR had excellent sensitivity of 100% in apical and obstructive HCM while EMB had better sensitivity in dilated HCM. Moreover, CMR had good sensitivity of 84% in patients without wall thinning (relative true positive fraction 0.78, 95% CI 0.61–0.99).
Conclusions: Noninvasive CMR had an excellent ability to diagnose the patients with heart failure equal to or better than invasive EMB. Particularly CMR may be suitable for the patients without wall thinning. We are urged to consider and use CMR for the quality diagnosis of heart failure besides or instead of EMB.
- © 2010 by American Heart Association, Inc.