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European Heart Journal Advance Access originally published online on September 1, 2008
European Heart Journal 2008 29(20):2544-2551; 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
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact 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; online publish-ahead-of-print 1 September 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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