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European Heart Journal Advance Access published online on September 1, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn381
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Combined coronary and late-enhanced multidetector-computed tomography for delineation of the etiology of left ventricular dysfunction: comparison with coronary angiography and contrast-enhanced cardiac magnetic resonance imaging

Jean-Benoît le Polain de Waroux, Anne-Catherine Pouleur, Céline Goffinet, Agnès Pasquet, Jean-Louis Vanoverschelde and Bernhard L. Gerber*

Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St Luc UCL, Av Hippocrate 10/2806, B-1200 Woluwe St Lambert, Brussels, Belgium

Received 18 February 2008; revised 27 June 2008; accepted 25 July 2008.

* Corresponding author. Tel: +32 2 7642803, Fax: +32 2 7648980, Email: bernhard.gerber{at}uclouvain.be

Aims: To evaluate whether comprehensive evaluation of coronary anatomy and delayed enhancement (DE) by multidetector-computed tomography (MDCT) would allow determination of etiology of left ventricular dysfunction (LVD) as compared with coronary angiography (CA) and DE-magnetic resonance (CMR).

Methods and results: Seventy-one consecutive patients (50 males, 59 ± 16 years) with LVD (ejection fraction: 26 ± 11%) of unknown etiology underwent MDCT, LGE (late Gd-DTPA-enhanced)-CMR and CA. Patients were classified into four groups according to coronary artery disease (CAD) by CA and LGE-CMR patterns. Patients (n = 24) with CAD and transmural or sub-endocardial DE by CMR were considered having definite ischaemic LVD (group 1). Patients (n = 36) without CAD by CA and with no/atypical LGE-CMR were considered non-ischaemic LVD (group 2). Further we identified four patients with transmural DE but no CAD (group 3) and seven patients with CAD but no DE (group 4). On per-patient basis, combined coronary and DE-MDCT had excellent agreement ({kappa} = 0.89; P < 0.001) with CA/LGE-CMR to classify patients into the same four groups. Sensitivity, specificity and accuracy of MDCT were 97, 92 and 94%, respectively for detecting patients with definite (group 1) or likely (groups 3 and 4) ischaemic LVD.

Conclusion: Combined coronary and DE-MDCT can accurately differentiate ischaemic vs. non-ischaemic etiology of LVD.

Key Words: Computed tomography • Left ventricular dysfunction • Magnetic resonance imaging • Coronary angiography • Dilated cardiomyopathy • Infarct


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