Abstract 17209: Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance versus Invasive Coronary Angiography: A Meta-Analysis on Diagnostic Accuracy for Cardiovascular Ischemia

Abstract

Introduction: Invasive Coronary Angiography (ICA) has been the gold standard for diagnosing cardiovascular ischemia, however, it carries an inherent risk due to its invasive nature. Late Gadolinium Enhancement (LGE) by Cardiovascular Magnetic Resonance (CMR) is a promising non-invasive alternative. This necessitates determining its diagnostic accuracy to inform clinical decision-making. Hypothesis: This study aims to assess the diagnostic accuracy of LGE by CMR and ICA in detecting cardiovascular ischemia. Methods: We performed a systematic review of studies until January 2023 across multiple databases, including PubMed, Embase, and the Cochrane Library, that compared the diagnostic accuracy of LGE by CMR and ICA for cardiovascular ischemia. Diagnostic performance measures, including sensitivity, specificity, false-positive rate estimates, diagnostic odds ratio, and positive and negative Likelihood Ratios (LR), were pooled using a random-effects model and presented with a 95% Confidence Interval (CI). R software (version 4.0.3) with the mada package was utilized for statistical analyses. Results: Our meta-analysis collected data from 8 studies encompassing 1,020 patients, of which 395 had confirmed ischemic imaging and 625 had confirmed non-ischemic heart imaging. The results revealed that LGE by CMR had high diagnostic accuracy for detecting cardiovascular ischemia. The sensitivity was 90.9% (95% CI: 80.2%-96.1%, I2=50.4%), the specificity was 89.3% (95% CI: 79.2%-94.8%, I2=90.5%), and the false-positive rate was 10.7% (95% CI: 5.2%-20.8%). The diagnostic odds ratio for LGE by CMR was 82.82 (95% CI: 25.2-272.5), and the positive and negative Likelihood Ratios were 8.46 (95% CI: 4.19-17.06) and 0.10 (95% CI: 0.05-0.23), respectively. Conclusions: This study demonstrates the high diagnostic accuracy of LGE by CMR for cardiovascular ischemia, as indicated by its high sensitivity, specificity, and substantial diagnostic odds ratio. These findings suggest that LGE by CMR could be a reliable non-invasive alternative to ICA, potentially improving clinical decision-making and reducing risks associated with invasive imaging. Further studies and policy reviews are needed to optimize the use of this promising diagnostic modality.