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Multicenter Study
. 2025 Sep 25;111(20):969-975.
doi: 10.1136/heartjnl-2024-325419.

Diagnostic accuracy of late gadolinium enhancement cardiac MRI for coronary artery disease in patients with reduced left ventricular ejection fraction

Louis-Marie Desroche  1   2 , Arthur Darmon  3 , Yoan Lavie-Badie  4 , Damien Mandry  5 , Gregory Ducrocq  6   7   8   9 , Thiziri Si-Moussi  10 , Isabelle Durand-Zaleski  11   12 , Damien Millischer  13 , Olivier Milleron  6 , Olivier Huttin  14   15   16   17 , Mathieu Valla  18 , Lionel Mangin  19 , Bruno Farah  20 , Christelle Diakov  21 , Damien Logeart  22 , Benjamin Safar  23 , Jean-Yves Travers  24 , Jules Mesnier  6 , Alexandra Vappereau  11 , Toni Alfaiate  25 , Charles Burdet  25   26 , Guillaume Jondeau  6   7   9 ; CAMAREC investigators
Collaborators, Affiliations
Multicenter Study

Diagnostic accuracy of late gadolinium enhancement cardiac MRI for coronary artery disease in patients with reduced left ventricular ejection fraction

Louis-Marie Desroche et al. Heart. .

Abstract

Background: Identifying significant coronary artery disease (CAD) in patients with reduced left ventricular ejection fraction (rLVEF) is essential for guiding therapeutic decisions, including medical management, device implantation and potential revascularisation. Prior studies suggested that rest cardiac MRI (CMR) with late gadolinium enhancement (LGE) could reliably detect significant CAD. We aimed to evaluate the diagnostic accuracy of rest LGE-CMR for predicting significant CAD in rLVEF patients.

Methods: In this prospective, multicentre cohort study across 10 centres, adults with new-onset rLVEF≤45% without obvious cause were included. All patients underwent rest CMR and coronary angiography. Independent, blinded committees reviewed images. Significant CAD was defined as ≥70% stenosis in major coronary arteries. Ischaemic scars were identified on CMR as subendocardial LGE. The primary outcome was the sensitivity of CMR in detecting significant CAD.

Results: Among 380 patients (median age 63 years, 68% male), significant CAD was present in 49 (13%). CMR identified ischaemic scars in 106 (28%). The sensitivity of CMR for detecting significant CAD was 57% (95% CI: 43% to 71%), specificity 76% (95% CI: 72% to 81%), positive predictive value 26% (95% CI: 18% to 35%) and negative predictive value 92% (95% CI: 89% to 95%). A CMR-first strategy would have missed 43% of significant CAD cases, many requiring revascularisation (86% of missed cases).

Conclusions: In this large, prospective multicentre study with independent image review, rest LGE-CMR demonstrated limited sensitivity for detecting significant CAD in patients with rLVEF. Relying solely on CMR could lead to missed diagnoses and undertreatment. CMR should be integrated with other diagnostic tools to optimise care in this population.

Trial registration number: NCT03231189.

Keywords: Coronary artery disease; Health Care Economics and Organizations; Heart Failure, Systolic; Magnetic Resonance Imaging.

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Conflict of interest statement

Competing interests: YL-B: consulting fees from Abbott, GE Healthcare; AD: consulting fees from Boston Scientific, research grants from Abbott, travel fees from Alvi Medica and Bayer. CD: consulting fees from Abbott, Philips; ID-Z: consulting fees from: Abbott, BMS, Boston-scientific, MSD, Pfizer, Roche, Sanofi, Takeda; GF: Speaker and/or consulting fees: Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boston Scientific, BMS, Novo Nordisk, Sanofi, CEC, DSMB, Steering committee: Amgen, NovoNordisk, Janssen, Proctoring: Boston Scientific.

Figures

Figure 1
Figure 1. Flow chart of the study. CA, coronary angiography; CMR, cardiac MR; LVEF, left ventricular ejection fraction.
See this image and copyright information in PMC

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