Etiological Diagnosis of Left Ventricular Dysfunction: Computed Tomography Compared With Coronary Angiography and Cardiac Magnetic Resonance

• Published in: Revista española de cardiología (English ed.) 2012-06, Vol.65 (6), p.517-524
• Main Authors: Estornell-Erill, Jordi, Igual-Muñoz, Begoña, Monmeneu-Menadas, Jose Vicente, Soriano-Navarro, Carlos, Valle-Muñoz, Alfonso, Vilar-Herrero, Juan V., Perez-Bosca, Leandro, Paya-Serrano, Rafael, Martinez-Alzamora, Nieves, Ridocci-Soriano, Francisco
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Calcinosis - complications; Calcinosis - diagnosis; Cardiac magnetic resonance; Coronariografía; Coronary angiography; Coronary Angiography - methods; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector computed tomography; Multidetector Computed Tomography - methods; Necrosis; Prospective Studies; Resonancia magnética cardiaca; Sensitivity and Specificity; Tomografía computarizada con multidetectores; Ventricular Dysfunction, Left - etiology
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2011.07.011

To evaluate the capability of multidetector computed tomography to diagnose the coronary etiology of left ventricular dysfunction compared with using invasive coronary angiography and magnetic resonance. Forty consecutive patients with left ventricular dysfunction of uncertain etiology underwent invasive coronary angiography and contrast magnetic resonance. All patients were evaluated with multidetector computed tomography including coronary calcium presence and score, noninvasive coronary angiography, and myocardial tissue assessment. The sensitivity and specificity of the presence of coronary calcium to identify left ventricular dysfunction was 100% and 31%, respectively. If an Agatston calcium score of >100 is taken, specificity increases to 58% with sensitivity still 100%. Sensitivity and specificity for coronary angiography by multidetector computed tomography was 100% and 96%, respectively; for identifying necrosis in contrast acquisition it was 57% and 100%, respectively; and in late acquisition, 84% and 96%, respectively. To identify coronary ventricular dysfunction with necrosis, the sensitivity and specificity was 92% and 100%, respectively. Of all the diagnostic tools available in multidetector computed tomography, coronary angiography is the most accurate in determining the coronary origin of left ventricular dysfunction. A combination of coronary angiography and myocardial tissue study after contrast allows a single test to obtain similar information compared with the combination of invasive coronary angiography and contrast magnetic resonance. Evaluar la capacidad de la tomografía computarizada con multidetectores en el diagnóstico de la disfunción ventricular izquierda de origen coronario y valorar su exactitud diagnóstica comparándola con la combinación de coronariografía invasiva y resonancia magnética. Se estudió a 40 pacientes consecutivos con disfunción ventricular izquierda de origen no filiado mediante coronariografía invasiva y resonancia con contraste. A todos ellos se les realizó además un estudio de tomografía computarizada con multidetectores incluyendo presencia de calcio coronario y su cuantificación, coronariografía y valoración tisular del miocardio. La sensibilidad y la especificidad de la presencia de calcio coronario para identificar la disfunción ventricular izquierda de origen coronario fueron del 100 y el 31% respectivamente. Si se considera un score de calcio por Agatston >100, la especificidad sube al 58% manteniendo