Author + information
- Received October 23, 2013
- Revision received December 24, 2013
- Accepted January 3, 2014
- Published online May 1, 2014.
- Ify Mordi, MBChB∗,
- Tony Stanton, PhD†,
- David Carrick, MBChB∗,
- John McClure, PhD∗,
- Keith Oldroyd, MD‡,
- Colin Berry, PhD∗,‡ and
- Nikolaos Tzemos, MD∗,‡∗ ()
- ∗British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- †Cardiovascular Imaging Research Centre, School of Medicine, University of Queensland, Brisbane, Australia
- ‡West of Scotland Regional Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Nikolaos Tzemos, British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Avenue, Glasgow, Scotland G12 8TA, United Kingdom.
Objectives This study aimed to compare dobutamine stress cardiac magnetic resonance (DSCMR) with dobutamine stress echocardiography (DSE) in patients with left bundle branch block (LBBB) and suspected coronary artery disease (CAD).
Background Noninvasive diagnosis of CAD in patients with pre-existent LBBB is difficult because single-photon emission computed tomography and stress echocardiography both have limitations. We hypothesized that a comprehensive DSCMR examination including cine, perfusion, and late gadolinium enhancement imaging would be more accurate than DSE, thus potentially reducing the number of unnecessary invasive coronary angiograms.
Methods We prospectively evaluated 82 consecutive patients with LBBB referred to our cardiology clinic for investigation of suspected CAD. All 82 patients underwent DSE, DSCMR, and invasive quantitative coronary angiography within 14 days. We compared the diagnostic accuracy of DSE, CMR cine imaging, the additive value of first-pass perfusion, and late gadolinium enhancement. In the comprehensive examination, a positive result was adjudged as the presence of either subendocardial or transmural late gadolinium enhancement with or without inducible peri-infarct ischemia or an inducible perfusion defect corresponding to an inducible regional wall motion abnormality.
Results CMR cine imaging (regional wall motion abnormalities) had higher specificity, negative predictive value, and overall diagnostic accuracy than did DSE (87.5% vs. 72.9%; 80.8% vs. 67.3%; and 80.4% vs. 72.0%, respectively), although sensitivity was the same (72.0%). The addition of first-pass stress perfusion and late gadolinium enhancement (scar) further improved diagnostic confidence (sensitivity 82.4%, specificity 95.8%, positive predictive value 93.3%, negative predictive value 88.5%, and diagnostic accuracy 90.2%).
Conclusions DSCMR is a safe procedure and has greater diagnostic accuracy than does DSE in assessing patients with suspected CAD and LBBB. A comprehensive examination with the addition of perfusion and late gadolinium enhancement to CMR cine imaging significantly boosted specificity and sensitivity, making DSCMR a reliable alternative to invasive quantitative coronary angiography in this group of patients.
Dr. Berry has received honoraria from St. Jude Medical and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 23, 2013.
- Revision received December 24, 2013.
- Accepted January 3, 2014.
- American College of Cardiology Foundation