Cardiac Magnetic Resonance for Excluding Coronary Artery Disease in Left Ventricular Dysfunction: The Camarec Study

Speaker(s)

Desroche LM1, Darmon A2, Lavie-Badie Y3, Mandry D4, Ducrocq G5, Simoussi T1, Durand Zaleski I6, Millischer D7, Milleron O8, Huttin O9, Valla M10, Mangin L11, Farah B12, Diakov C13, Logeart D14, Safar B15, Travers JY16, Mesnier J17, Alfaiate T18, Burdet C19, Jondeau G20, Vappereau A21
1Département de Cardiologie, Hôpital Universitaire de La Réunion, Saint-Denis, Réunion, Reunion, 2Département de Cardiologie, Centre Cardiologique du Nord, Saint-Denis, France, Saint Denis, Ile de France, France, 3Département de Cardiologie, Hôpital Universitaire de Toulouse, Toulouse, France, Toulouse, Occitanie, France, 4Département de Radiologie, Hôpital Universitaire de Nancy, Nancy, France, Nancy, Grand Est, France, 5Département de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Paris, France; Université de Paris, Paris Cité, France; INSERM U1148, LVTS, Hôpital Bichat, Paris, France; French Alliance for Cardiovascular Trials (FACT), Paris, France, 6URCEco, AP-HP, Hôpital de l’Hôtel Dieu, F-75004, Paris, 75, France, 7Département de Cardiologie, Hôpital Universitaire de La Réunion; Centre d’Investigations Clinique - Épidémiologie Clinique INSERM 1410, Hôpital Universitaire de La Réunion, France, Saint-Denis, Réunion, Reunion, 8Université de Paris, Paris Cité, France, Paris, France, 9Département de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux, Centre Hospitalier Universitaire de Nancy, France; Université de Lorraine, Nancy, France; Centre d’Investigations Cliniques-1433 de l'Hôpital Universitaire de Nancy, Nancy, France, 10Département de Cardiologie, Hôpital Mercy, CHR Metz -Thionville, France, Metz, France, 11Département de Cardiologie, Centre Hospitalier Annecy Genevois, 1 avenue de l’hôpital, 74370 Epagny Metz-Tessy, France, Annecy, France, 12Département de Cardiologie, Clinique Pasteur, Toulouse, France, Toulouse, France, 13Département de Cardiologie, Institut Mutualiste Montsouris, 42 boulevard Jourdan 75014 Paris, France, Paris, France, 14AP-HP - Hospital Lariboisière, Paris, France, 15Département de Cardiologie, Hôpital de Montfermeil, Montfermeil, France, Montfermeil, France, 16Département de Radiologie, Hôpital Universitaire de La Réunion, Saint-Denis, Réunion, France, Saint-Denis, Reunion, 17Département de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Paris, France, Paris, France, 18Département d’épidémiologie, biostatistique et Recherche Clinique, Hôpital Bichat, Assistance-Publique – Hôpitaux de Paris, Paris, France, Paris, France, 19INSERM, Paris, France, 20Département de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Paris, France; Université de Paris, Paris Cité, France; INSERM U1148, LVTS, Hôpital Bichat, Paris, France, Paris, France, 21Unité de Recherche Clinique en Économie de la Santé (URC-Eco), AP-HP, Hôtel Dieu, Paris, France, Paris, 75, France

Presentation Documents

BACKGROUND: Cardiac Magnetic Resonance (CMR) is recommended for patients with unexplained reduced left ventricular ejection fraction (rLVEF). The reliability of first line CMR as a screening tool for ruling out ischemic cardiomyopathy in patients with rLVEF has been suggested, but not rigorously evaluated.

OBJECTIVES: To assess the diagnostic performance of CMR to predict significant CAD in patients with unexplained rLVEF, and the cost-effectiveness of a modeled CMR-first strategy

METHODS: CAMAREC is a multicenter prospective cohort study including patients aged 18 years or older with newly detected rLVEF (≤ 45%). All participants underwent first CMR and then CA within two weeks, with each modality independently reviewed by blinded committees. CMR ischemic scar was defined by subendocardial late gadolinium enhancement in at least one segment. Significant CAD was defined as ≥70% stenosis in pre-specified major coronary arteries. The primary endpoint was the sensitivity of CMR to predict significant CAD, and secondary endpoints included diagnostic performance measures and the cost-effectiveness of a CMR-first strategy.

RESULTS: From 2018 to 2021, 380 patients from 10 French centers participated. The sensitivity of CMR was 57% [95% CI: 43-71] and specificity 76% [95% CI: 72-81]. The positive predictive value was 26% [95% CI: 18-35] and negative predictive value 92% [95% CI: 89-95]. A CMR-first strategy could have saved €586 per patient by avoiding 274 CA procedures, but missed CAD in 21 patients (6%) and indication for revascularization in 18 (5%).

CONCLUSIONS: Although performing CMR alone to exclude significant CAD in rLVEF patients would be cost-saving, its low sensitivity does not support such a diagnostic strategy.

Code

EE182

Topic

Clinical Outcomes, Economic Evaluation, Medical Technologies

Topic Subcategory

Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy, Cost-comparison, Effectiveness, Utility, Benefit Analysis, Diagnostics & Imaging

Disease

Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas