Original Research
CMR Imaging Assessing Viability in Patients With Chronic Ventricular Dysfunction Due to Coronary Artery Disease: A Meta-Analysis of Prospective Trials

https://doi.org/10.1016/j.jcmg.2012.02.009Get rights and content
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Objectives

The purpose of this study was to compare the diagnostic accuracy of cardiac magnetic resonance (CMR) assessing myocardial viability in patients with chronic left ventricular (LV) dysfunction due to coronary artery disease using 3 techniques: 1) end-diastolic wall thickness (EDWT); 2) low-dose dobutamine (LDD); and 3) contrast delayed enhancement (DE).

Background

CMR has been proposed to assess myocardial viability over the past decade. However, the best CMR strategy to evaluate patients being contemplated for revascularization has not yet been determined. Some centers advocate DE CMR due to its high sensitivity to identify scar, whereas others favor the use of LDD CMR for its ability to identify contractile reserve.

Methods

A systematic review of MEDLINE, Cochrane, and Embase for all the prospective trials assessing myocardial viability in subjects with chronic LV dysfunction using CMR was performed using a standard approach for meta-analysis for diagnostic tests and a bivariate analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results

A total of 24 studies of CMR evaluating myocardial viability with 698 patients fulfilled the inclusion criteria. Eleven studies used DE, 9 studies used LDD, and 4 studies used EDWT. Our meta-analysis indicates that among CMR methods, DE CMR provides the highest sensitivity as well as the highest NPV (95% and 90%, respectively) for predicting improved segmental LV contractile function after revascularization, followed by EDWT CMR, whereas LDD CMR demonstrated the lowest sensitivity/NPV among all modalities. On the other hand, LDD CMR offered the highest specificity and PPV (91% and 93%, respectively), followed by DE CMR, whereas EDWT showed the lowest of these parameters.

Conclusions

DE CMR provides the highest sensitivity and NPV, whereas LDD CMR provides the best specificity and PPV. In light of these findings, integrating these 2 methods should provide increased accuracy in evaluating patients with chronic LV dysfunction being considered for revascularization.

Key Words

cardiac magnetic resonance
left ventricular dysfunction
myocardial viability
revascularization

Abbreviations and Acronyms

CABG
coronary artery bypass graft
CAD
coronary artery disease
CI
confidence interval
CMR
cardiac magnetic resonance
DE
contrast delayed enhancement
DSE
dobutamine stress echocardiography
EDWT
end-diastolic wall thickness
LDD
low-dose dobutamine
LV
left ventricular
MRI
magnetic resonance imaging
NPV
negative predictive value
PCI
percutaneous coronary intervention
PET-FGD
positron emission tomography with fluorine-18 deoxyglucose
PPV
positive predictive value
QUADAS
quality assessment of diagnostic accuracy studies instrument
ROC
receiver-operating characteristic
SPECT
single-photon emission computed tomography

Cited by (0)

Dr. Garcia is a consultant to TheHeart.org. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The use of gadolinium contrast agents for myocardial imaging is not an FDA approved indication.