Late gadolinium enhancement-cardiovascular magnetic resonance identifies coronary artery disease as the aetiology of left ventricular dysfunction in acute new-onset congestive heart failure
Late gadolinium enhancement-cardiovascular magnetic resonance identifies coronary artery disease as the aetiology of left ventricular dysfunction in acute new-onset congestive heart failure
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DOI：
10.1093/ejechocard/jep115
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发表时间：
2009-12-01
影响因子：
--
通讯作者：
Ridocci-Soriano, Francisco
中科院分区：
文献类型：
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作者：
Valle-Munoz, Alfonso;Estornell-Erill, Jordi;Ridocci-Soriano, Francisco
我们使用心血管磁共振（CMR）评估晚期钆增强（LGE）识别急性新发心力衰竭（HF）合并左心室收缩功能障碍（LVSD）的能力，无论是否与潜在冠状动脉疾病（CAD）有关，在没有相关缺血性心肌病临床证据的患者中。100例连续入院的急性新发失代偿性心衰和EF < 40%的患者，没有临床或心电图数据提示CAD。根据是否存在明显的冠心病（至少一条主要血管狭窄>= 70%）对患者进行分类。21例（21%）患者有明显的冠心病。79例（79%）无病变。21例CAD患者中有18例（85%）患有心内膜下/经壁LGE。在CAD诊断中，LGE的敏感性为85.7% (95% CI, 80-91)，特异性为92.4% (95% CI, 87-96)，阴性预测值为96% （95% CI, 90-99）。其受试者工作特征曲线下面积为0.906 （95% CI, 0.814-0.998）。在没有临床和探索性数据提示缺血性心脏病的新发HF和LVSD患者中，CMR与LGE是排除显著CAD的绝佳手段，是血管造影的有效替代方法。
We evaluated the ability of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance (CMR) to identify acute new-onset heart failure (HF) with left ventricular systolic dysfunction (LVSD), whether or not in relation to underlying coronary artery disease (CAD), in patients with no clinical evidence of associated ischaemic cardiomyopathy.Hundred consecutive patients admitted with acute new-onset decompensated HF and EF < 40%, with no clinical or electrocardiographic data suggestive of CAD. The patients were classified according to the presence or absence of significant CAD (stenosis >= 70% in at least one major vessel). Twenty-one patients (21%) had significant CAD. Seventy-nine (79%) had no lesions. Eighteen of the 21 patients (85%) with CAD had subendocardial/transmural LGE. In the diagnosis of CAD, LGE has a sensitivity of 85.7% (95% CI, 80-91) and specificity of 92.4% (95% CI, 87-96), respectively, with a negative predictive value of 96% (95% CI, 90-99). It has an area under the receiver operating characteristic curve of 0.906 (95% CI, 0.814-0.998).In patients with new-onset HF and LVSD for whom there are no clinical and exploratory data suggestive of ischaemic heart disease, CMR with LGE is an excellent means of ruling out significant CAD and is a valid alternative to angiography.