50 Survey of UK cardiologists on the use of CT coronary angiography and cardiac MRI in the diagnosis of aetiology of heart failure/impaired LV function

Abstract

Introduction Traditionally, the aetiology of heart failure/impaired LV function is investigated with diagnostic invasive coronary angiography. More recently, Cardiac MRI tissue characterisation was proposed as an effective alternative test. There is debate as to whether this is sufficient or if coronary angiography is still required. CT coronary angiography (CTCA) is a low cost alternative test to image the coronary arteries, but requires a relatively slow regular heart rhythm for a successful scan. We wanted to explore UK cardiologists views on the investigation of aetiology of heart failure/impaired LV function. Methods A short questionnaire was designed using electronic survey software. It was e-mailed to UK cardiologists through a cardiologists directory. Results A total of 887 consultants were emailed, with 257 opening the email and 149 responses were obtained. 55% of respondents felt cardiac MRI alone was sufficient to differentiate ischaemic versus non-ischaemic cardiomyopathy. Approximately 56% however still felt invasive coronary angiography was still required. Almost 70% felt CTCA could be used as an alternative to invasive coronary angiography. Of the 30% of cardiologists who did not agree with the use of CTCA as an alternative to invasive coronary angiography, 22% stated that this was because invasive angiography was a superior test, 20% stated that CTCA would be technically challenging in heart failure patients but the majority (58%) stated that both were reasons not to use CTCA in heart failure. Discussion 55% of UK cardiologists only feel that Cardiac MRI is sufficient for the diagnosis of aetiology of heart failure/impaired LV function. 70% felt that CTCA could be an alternative to invasive coronary angiography in this patient group. But there was a valid concern about the quality and feasibility of CTCA in heart failure patients who tend to have faster heart rates with ectopic beats which would be challenging on 64 slice CT scanners, but not on high specification CT scanners.