PMID- 21900085
OWN - NLM
STAT- MEDLINE
DCOM- 20111115
LR  - 20191210
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 124
IP  - 12
DP  - 2011 Sep 20
TI  - Role of cardiovascular magnetic resonance as a gatekeeper to invasive coronary 
      angiography in patients presenting with heart failure of unknown etiology.
PG  - 1351-60
LID - 10.1161/CIRCULATIONAHA.110.011346 [doi]
AB  - BACKGROUND: In patients presenting with new-onset heart failure of uncertain 
      etiology, the role of coronary angiography (CA) is unclear. Although 
      conventionally performed to differentiate underlying coronary artery disease from 
      dilated cardiomyopathy, CA is associated with a risk of complications and may not 
      detect an ischemic cause resulting from arterial recanalization or an embolic 
      episode. In this study, we assessed the diagnostic accuracy of a cardiovascular 
      magnetic resonance (CMR) protocol incorporating late gadolinium enhancement (LGE) 
      and magnetic resonance CA as a noninvasive gatekeeper to CA in determining the 
      etiology of heart failure in this subset of patients. METHODS AND RESULTS: One 
      hundred twenty consecutive patients underwent CMR and CA. The etiology was 
      ascribed by a consensus panel that used the results of the CMR scans. Similarly, 
      a separate consensus group ascribed an underlying cause by using the results of 
      CA. The diagnostic accuracy of both strategies was compared against a 
      gold-standard panel that made a definitive judgment by reviewing all clinical 
      data. The study was powered to show noninferiority between the 2 techniques. The 
      sensitivity of 100%, specificity of 96%, and diagnostic accuracy of 97% for 
      LGE-CMR were equivalent to CA (sensitivity, 93%; specificity, 96%; and diagnostic 
      accuracy, 95%). As a gatekeeper to CA, LGE-CMR was also found to be a cheaper 
      diagnostic strategy in a decision tree model when United Kingdom-based costs were 
      assumed. The economic merits of this model would change, depending on the 
      relative costs of LGE-CMR and CA in any specific healthcare system. CONCLUSION: 
      This study showed that LGE-CMR is a safe, clinically effective, and potentially 
      economical gatekeeper to CA in patients presenting with heart failure of 
      uncertain etiology.
FAU - Assomull, Ravi G
AU  - Assomull RG
AD  - Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.
FAU - Shakespeare, Carl
AU  - Shakespeare C
FAU - Kalra, Paul R
AU  - Kalra PR
FAU - Lloyd, Guy
AU  - Lloyd G
FAU - Gulati, Ankur
AU  - Gulati A
FAU - Strange, Julian
AU  - Strange J
FAU - Bradlow, William M
AU  - Bradlow WM
FAU - Lyne, Jonathan
AU  - Lyne J
FAU - Keegan, Jennifer
AU  - Keegan J
FAU - Poole-Wilson, Philip
AU  - Poole-Wilson P
FAU - Cowie, Martin R
AU  - Cowie MR
FAU - Pennell, Dudley J
AU  - Pennell DJ
FAU - Prasad, Sanjay K
AU  - Prasad SK
LA  - eng
GR  - British Heart Foundation/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Validation Study
DEP - 20110906
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
CIN - Circulation. 2012 Jun 19;125(24):e1041; author reply e1042. PMID: 22711673
MH  - Aged
MH  - Cardiac Imaging Techniques/economics/*standards/statistics & numerical data
MH  - *Coronary Angiography/economics
MH  - Decision Trees
MH  - Female
MH  - Follow-Up Studies
MH  - Gadolinium
MH  - Health Care Costs
MH  - Heart Failure/*diagnosis/economics/*etiology
MH  - Humans
MH  - Magnetic Resonance Imaging/economics/*standards/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Observer Variation
MH  - Referral and Consultation/economics/standards/statistics & numerical data
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - United Kingdom
EDAT- 2011/09/09 06:00
MHDA- 2011/11/16 06:00
CRDT- 2011/09/09 06:00
PHST- 2011/09/09 06:00 [entrez]
PHST- 2011/09/09 06:00 [pubmed]
PHST- 2011/11/16 06:00 [medline]
AID - CIRCULATIONAHA.110.011346 [pii]
AID - 10.1161/CIRCULATIONAHA.110.011346 [doi]
PST - ppublish
SO  - Circulation. 2011 Sep 20;124(12):1351-60. doi: 10.1161/CIRCULATIONAHA.110.011346. 
      Epub 2011 Sep 6.