Does CMR have an additive role over echo in evaluating ischemic LV dysfunction?

Abstract

Purpose To emphasis the role of cardiac magnetic resonance compared to echocardiography in evaluating patients with ischemic cardiomyopathy to accurately assess global and regional Left ventricular function which is essential for prognosis and for evaluating therapeutic responses. Methods and materials The studied group included 37 patients already diagnosed as having ischemic cardiomyopathy. All patients were subjected to full history taking and radiological evaluation using a 1.5-T MR system and echocardiography. Comparison was made between echocardiography and cardiac magnetic resonance regarding segmental wall motion by using the 17-segment model of the American Heart Association. Agreement regarding segmental wall motion was assessed by using Cohen's Kappa statistics. Also ejection fraction measurement by both modalities was compared. Detection of transmural extent of myocardial scar was also performed. Results Poor agreement between cardiac magnetic resonance and echocardiography regarding segmental wall motion with Cohen's Kappa is 0.195, P value of <0.001. Mean ejection fraction by cardiac magnetic resonance was 33.3% and mean ejection fraction by echocardiography was 29% with a mean difference of 4.3%. Conclusion Cardiac magnetic resonance is superior to echo in evaluating segmental wall motion abnormality with echo underestimating segmental wall motion abnormality yet nearly similar ejection fraction values by both modalities were achieved. Moreover, cardiac magnetic resonance is better in evaluating associated cardiac abnormalities as well as extracardiac findings due to its higher spatial resolution. In addition, cardiac magnetic resonance is used in myocardial viability assessment in the same setting which if combined with segmental wall motion abnormality can lend a hand in evaluating the cardiac contractile reserve. © 2013 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Radiology and Nuclear Medicine.