Role of delayed contrast enhancement cardiovascular magnetic resonance at 3.0 Tesla in patients with chronic heart failure

IntroductionCardiovascular magnetic resonance (CMR) with delayed contrast enhancement (DCE) has been recently emerged as an easy-to-perform method for differentiation between normal and diseased myocardium. The aim of this study was to delineate the etiology of chronic heart failure (CHF) non-invasively using DCE-CMR at 3.0 Tesla.MethodsThirty-four patients with CHF, left ventricular ejection fraction (LVEF) <40%, and no clear history or objective evidence of coronary artery disease (CAD) were evaluated by contrast-enhanced CMR (Philips Achiva 3.0 T) and conventional coronary angiography. Significant CAD was defined as >50% diameter stenosis of major epicardial coronary vessel.ResultsFifteen patients showed subendocardial and/or transmural pattern of DCE (group A). Nineteen patients showed pattern of mid wall and/or subepicardial or no DCE (group B). Group A patients were older (52 ± 9 vs. 45 ± 10 years, p = 0.042), had higher prevalence of diabetes mellitus, hypertension and dyslipidemia, p = 0.001. LVEF was comparable in both groups. Coronary angiography showed significant CAD in 14/15 patients in group A. The other patient had coronary artery ectasia of the left anterior descending coronary artery. Normal angiogram was seen in 18/19 patients in group B. The other patient had 60% diameter stenosis of mid dominant right coronary artery. The sensitivity and specificity of DCE-CMR for detection of CAD were 93.3% and 94.7% respectively. The positive likelihood ratio was 17.74.ConclusionPattern of DCE-CMR at 3.0 Tesla may help delineation of etiology of CHF and makes clear distinction between ischemic and non-ischemic pathomorphology.