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

Author(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

Poster ISPOR - 2024 - AVAPPEREAU142626.pdf

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.

Conference/Value in Health Info

2024-11, ISPOR Europe 2024, Barcelona, Spain

Value in Health, Volume 27, Issue 12, S2 (December 2024)

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

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