European Journal of Echocardiography Advance Access originally published online on September 15, 2009
European Journal of Echocardiography 2009 10(8):968-974; doi:10.1093/ejechocard/jep115
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Late gadolinium enhancement–cardiovascular magnetic resonance identifies coronary artery disease as the aetiology of left ventricular dysfunction in acute new-onset congestive heart failure
1 Servicio de Cardiologia, Consorcio Hospital General Universitario de Valencia, Avda. Tres Cruces 2, 46014 Valencia, Spain
2 Unidad Imagen Cardiaca. ERESA, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
3 Departamento Estadistica e Investigación Operativa Aplicadas y Calidad, ETS Ingeniería del Diseño, Universidad Politecnica Valencia, Valencia, Spain
4 Departamento de Medicina, Universitat de Valencia, Valencia, Spain
Received 14 May 2009; accepted after revision 20 August 2009; online publish-ahead-of-print 15 September 2009.
* Corresponding author. Tel: +34 961972000; fax: +34 961972161. E-mail address: ridocci_fra{at}gva.es
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Abstract |
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Aims: 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.
Methods and results: 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).
Conclusion: 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.
Keywords: Acute heart failure; Ischaemic cardiomyopathy; Cardiovacular magnetic resonance; Late gadolinium enhancement; Diagnostic value