Diagnostic accuracy of late gadolinium enhancement cardiac MRI for coronary artery disease in patients with reduced left ventricular ejection fraction
Authors' conclusion
In this large, prospective multicentre study with independent image review, rest LGE-CMR demonstrated limited sensitivity for detecting significant CAD in patients with rLVEF. Relying solely on CMR could lead to missed diagnoses and undertreatment. CMR should be integrated with other diagnostic tools to optimise care in this population.
Study context
- Population
- Adults with new-onset reduced left ventricular ejection fraction (rLVEF)≤45% without obvious cause, undergoing rest cardiac MRI (CMR) and coronary angiographymedian age 63 years, 68% male
- Participants
- 380 adults
- Exposure
- Rest LGE-CMR against coronary angiography for detecting significant coronary artery disease (CAD)
- Outcome
- Sensitivity of CMR in detecting significant CAD
Methodological details10 centres, independent, blinded image review
- 10 centres
- Independent, blinded image review
Main finding
As reported in the abstract
Sensitivity (95% CI: 43% to 71%)
57%
Observational data: associations, not effects.
Further findings
Prevalence of significant CAD
- Significant CAD present
- 49 (13%)
Ischaemic scars on CMR
- CMR identified ischaemic scars
- 106 (28%)
Other diagnostic performance of CMR
- Specificity (95% CI: 72% to 81%)
- 76%
- Positive predictive value (95% CI: 18% to 35%)
- 26%
- Negative predictive value (95% CI: 89% to 95%)
- 92%
Missed significant CAD with a CMR-first strategy
- Significant CAD cases missed
- 43%
- Of missed cases, requiring revascularisation
- 86%
Original publication
Diagnostic accuracy of late gadolinium enhancement cardiac MRI for coronary artery disease in patients with reduced left ventricular ejection fraction. Heart. Published 27 March 2025. doi:10.
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