Persons presenting with heart failure and no overt features of coronary artery disease like angina are often considered for a diagnostic coronary angiography to exclude an ischemic and thereby reversible component for heart failure. There are significant risks for invasive coronary angiography in those with severe heart failure. Moreover, normal epicardial coronary arteries do not exclude previous occlusion followed by recanalisation or a transient embolic damage to the coronary territory. Hence Assomull RG and associates decided to check out heart failure patients with cardiovascular magnetic resonance (CMR) imaging along with late gadolinium enhancement (LGE) regarding ischemic territories prior to invasive coronary angiography [Role of Cardiovascular Magnetic Resonance as a Gatekeeper to Invasive Coronary Angiography in Patients Presenting With Heart Failure of Unknown Etiology. Circulation. 2011; 124: 1351-1360]. Hundred and twenty patients with heart failure underwent both CMR and coronary angiography. Follow up data with clinical outcomes at a median follow up of 3.7 years as well as the study data were analysed by an expert panel. CMR had a sensitivity of hundred percent and a specificity of ninety six percent. Diagnostic accuracy of CMR with LGE was ninety seven percent and equivalent to that of invasive coronary angiography. Though the economic benefit of CMR-LGE would change in different health care settings depending on the relative cost with respect to invasive coronary angiography, CMR-LGE can be considered as a gatekeeper to coronary angiography in heart failure of uncertain etiology as per the authors.
Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London
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28 Jul, 2011