The Role of Cardiac Imaging in the Evaluation of Newly Diagnosed Heart Failure

Abstract

Won et al, 1 Won E. Donnino R. Srichai M.B. Sedlis S.P. Feit F. Rolnitzky L. Miller L.H. Iqbal S.N. Axel L. Nguyen B. Slater J. Shah B. Diagnostic accuracy of cardiac magnetic resonance imaging in the evaluation of newly diagnosed heart failure with reduced left ventricular ejection fraction. Am J Cardiol. 2015; 116: 1082-1087 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar reported the potential utility of findings on late gadolinium enhancement (LGE) and cine images acquired with cardiac magnetic resonance imaging to differentiate ischemic from nonischemic cardiomyopathy in patients with newly diagnosed heart failure with reduced left ventricular ejection fraction. There are few comments on the method and finding of this study. First, 70% of study population had elevated troponin, which indicated high-risk group of patients with heart failure who might require more aggressive or invasive strategy than those without elevated troponin. 2 Peacock W.F. De M.T. Fonarow G.C. Diercks D. Wynne J. Apple F.S. Wu A.H. Cardiac troponin and outcome in acute heart failure. N Engl J Med. 2008; 358: 2117-2126 Crossref PubMed Scopus (568) Google Scholar , 3 Fonarow G.C. Peacock W.F. Horwich T.B. Phillips C.O. Givertz M.M. Lopatin M. Wynne J. Usefulness of B-type natriuretic peptide and cardiac troponin levels to predict in-hospital mortality from ADHERE. Am J Cardiol. 2008; 101: 231-237 Abstract Full Text Full Text PDF PubMed Scopus (138) Google Scholar Second, cardiac magnetic resonance images were acquired from either 1.5 T or 3.0 T magnetic resonance imaging (MRI) system. There were no validation data provided to demonstrate that the image parameters from 2 different MRI systems were comparable and did not affect the interpretation of wall motion, and the extent of defect seen in first pass perfusion and LGE images. The contrast-enhanced image qualities have been reported to be superior in 3.0 T MRI system with better signal and contrast to noise ratios compared with 1.5 T MRI system. 4 Klumpp B. Fenchel M. Hoevelborn T. Helber U. Scheule A. Claussen C. Miller S. Assessment of myocardial viability using delayed enhancement magnetic resonance imaging at 3.0 Tesla. Invest Radiol. 2006; 41: 661-667 Crossref PubMed Scopus (60) Google Scholar , 5 Theisen D. Wintersperger B.J. Huber A. Dietrich O. Reiser M.F. Schonberg S.O. Myocardial perfusion imaging with Gadobutrol: a comparison between 3 and 1.5 Tesla with an identical sequence design. Invest Radiol. 2007; 42: 499-506 Crossref PubMed Scopus (19) Google Scholar Third, 8% of ischemic cardiomyopathy group did not demonstrate LGE and the diagnostic accuracy of combined ischemic pattern from LGE and regional wall motion abnormality from cine images to detect ischemic cardiomyopathy was 71%. This may not provide enough confidence for clinicians to decide whether patients should undergo or omit invasive coronary angiography to exclude significant coronary artery disease. Additional information on the presence and extent of ischemic myocardium may be useful to guide management in these patients because the presence of inducible myocardial ischemia from stress cardiac magnetic resonance imaging was an important predictor for cardiac events. 6 Husser O. Monmeneu J.V. Bonanad C. Lopez-Lereu M.P. Nunez J. Bosch M.J. Garcia C. Sanchis J. Chorro F.J. Bodi V. Prognostic value of myocardial ischemia and necrosis in depressed left ventricular function: a multicenter stress cardiac magnetic resonance registry. Rev Esp Cardiol (Engl Ed). 2014; 67: 693-700 Crossref PubMed Scopus (9) Google Scholar Diagnostic Accuracy of Cardiac Magnetic Resonance Imaging in the Evaluation of Newly Diagnosed Heart Failure With Reduced Left Ventricular Ejection FractionAmerican Journal of CardiologyVol. 116Issue 7PreviewThe aim of this study was to determine the diagnostic value of cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE), cine imaging, and resting first-pass perfusion (FPP) in the evaluation for ischemic (IC) versus nonischemic (NIC) cardiomyopathy in new-onset heart failure with reduced (≤40%) left ventricular ejection fraction (HFrEF). A retrospective chart review analysis identified 83 patients from January 2009 to June 2012 referred for CMR imaging evaluation for new-onset HFrEF with coronary angiography performed within 6 months of CMR. Full-Text PDF ReplyAmerican Journal of CardiologyVol. 117Issue 3PreviewWe read the letter by Rerkpattanapipat et al and thank them for their comments regarding our study “diagnostic accuracy of cardiac magnetic resonance imaging in the evaluation of newly diagnosed heart failure with reduced left ventricular ejection fraction.”1 First, we agree that patients with an elevated troponin are at greater risk than those without elevated cardiac biomarkers. However, patients with newly diagnosed heart failure frequently have mildly elevated troponin levels, regardless of the origin. Full-Text PDF