Abstract 13632: Magnetic Resonance Imaging Assessing Viability in Patients with Chronic Ventricular Dysfunction Due to Coronary Artery Disease Undergoing Revascularization. A Meta-Analysis of Prospective Clinical Trials.
Background: The best test to evaluate myocardial viability in patients being contemplated for revascularization has not been determined. Magnetic resonance has emerged as a valuable tool for assessing it.
Objectives: The purpose of this study was to evaluate the sensitivity, specificity, negative and positive predictive values (PPV/NPV) of cardiac magnetic resonance imaging (CMR) assessing myocardial viability. Three different techniques were evaluated: 1) End-diastolic wall thickness (EDWT), 2) Low dose dobutamine (LDD), and 3) Contrast delayed-enhancement (DE).
Methods: A systematic review of Medline, Cochrane, and Embase for all the prospective trials assessing myocardial viability in subjects with chronic left ventricular dysfunction using CMR was performed using a hierarchical meta-analytical model.
Results: A total of 23 studies of cardiac magnetic resonance evaluating myocardial viability with 628 patients fulfilled the inclusion criteria. Eleven studies used DE CMR, nine studies used LDD CMR and three studies used EDWT. The DE CMR studies included a 50% of LV wall hyper-enhancement as a cut-off to determine viability. The mean sensitivity and specificity were 95% and 52%, whereas the PPV and NPV were 67% and 90%. LDD CMR used a two-millimeter change in LV wall motion during low-dose dobutamine infusion (5-10 mcg/kg/min) as a cut-off. In these studies the mean weighted sensitivity and specificity were 81% and 91%, whereas the PPV and NPV were 93% and 72% respectively. The cut-off used for EDWT was six millimeters. The mean weighted sensitivity and specificity were 96% and 40%, and the PPV and NPV were 66% and 80% respectively.
Conclusion: DE CMR provides the highest sensitivity and NPV of any diagnostic modality and LDD CMR provides the best specificity and PPV of any other test. Combining these two modalities might be therefore clinically meaningful to improve clinical outcomes and guiding management in patients being contemplated for revascularization.
- © 2011 by American Heart Association, Inc.