tests techniques for the EMB and ICA has higher population with DCM. rates of complications. B3. Accuracy N=136 Sensitivity = 0.83 CMR is reasonably good Moderate Diagnostic of CMR for (0.71, 0.92) at identifying DCM, performance diagnosing K=1 when compared with ⨁⨁⨁⨀ DCM clinical diagnosis and diagnostic Specificity = 0.93 EMB. However, these accuracy (0.85, 0.97) study findings were in studies that included patients other than those with an inconclusive echocardiogram. Accuracy K=8 Sensitivity = 0.68–1.00 A high proportion of Low of CMR at diagnostic those patients with ⊕⊕⨀⨀ accuracy NIDCM may avoid ICD Specificity = ICM studies insertion if imaged with to High from CMR. NIDCM (K=6 vs ⊕⊕⊕⊕ ICA, K=2 vs clinical diagnosis) B3. Diagnostic Accuracy K=1 Only very limited Conclusions on the Very low performance; of CMR vs diagnostic evidence compared comparative accuracy or B4.2. CTCA, accuracy prognostic benefit of with CTCA ⊕⨀⨀⨀ Prognosis or SPECT, or study; 2 CMR vs alternative predisposition stress echo prognostic Contradictory evidence techniques or contrast studies compared with SPECT cannot be made. echo No evidence compared with stress or contrast echocardiography. B5.1. Diagnostic N=102 CMR identified CMR provides unique Very low Therapeutic yield of aetiologies in 4/102 information, identifying a efficacy CMR in patients. small number of cases K=1 ⊕⨀⨀⨀ those comparative who would otherwise be classified diagnostic 3/4 aetiologies were classified as having as having idiopathic NIDCM. yield study not identified by any idiopathic other further test. DCM None of the other tests 1/4 patients were also could be replaced by CMR, as each reported identified by EMB. unique aetiologies. B4.2. LGE-CMR K=30 All-cause mortality RR Those with signs of Low Prognosis or for prospective = 2.47 (95%CI 1.63, scarring or inflammation ⊕⊕⨀⨀ predisposition or 3.74) on LGE-CMR had worse prognosis retrospective cardiac outcomes than to in those cohort those without signs, and Cardiac deaths RR = Moderate with 3.21 (95%CI 1.79, were more likely to have
tests techniques for the population with DCM. EMB and ICA has higher rates of complications. B3. Diagnostic performance Accuracy of CMR for diagnosing DCM N=136 K=1 diagnostic accuracy study Sensitivity = 0.83 (0.71, 0.92) Specificity = 0.93 (0.85, 0.97) CMR is reasonably good at identifying DCM, when compared with clinical diagnosis and EMB. However, these findings were in studies that included patients other than those with an inconclusive echocardiogram. Moderate ⨁⨁⨁⨀ Accuracy of CMR at ICM from NIDCM K=8 diagnostic accuracy studies (K=6 vs ICA, K=2 vs clinical diagnosis) Sensitivity = 0.68–1.00 Specificity = A high proportion of those patients with NIDCM may avoid ICD insertion if imaged with CMR. Low ⊕⊕⨀⨀ to High ⊕⊕⊕⊕ B3. Diagnostic performance; B4.2. Prognosis or predisposition Accuracy of CMR vs CTCA, SPECT, or stress echo or contrast echo K=1 diagnostic accuracy study; 2 prognostic studies Only very limited evidence compared with CTCA Contradictory evidence compared with SPECT No evidence compared with stress or contrast echocardiography. Conclusions on the comparative accuracy or prognostic benefit of CMR vs alternative techniques cannot be made. Very low ⊕⨀⨀⨀ B5.1. Therapeutic efficacy Diagnostic yield of CMR in those classified as having idiopathic DCM N=102 K=1 comparative diagnostic yield study CMR identified aetiologies in 4/102 patients. 3/4 aetiologies were not identified by any other further test. 1/4 patients were also identified by EMB. CMR provides unique information, identifying a small number of cases who would otherwise be classified as having idiopathic NIDCM. None of the other tests could be replaced by CMR, as each reported unique aetiologies. Very low ⊕⨀⨀⨀ B4.2. Prognosis or predisposition LGE-CMR for prognosis in those with K=30 prospective or retrospective cohort All-cause mortality RR = 2.47 (95%CI 1.63, 3.74) Cardiac deaths RR = 3.21 (95%CI 1.79, Those with signs of scarring or inflammation on LGE-CMR had worse cardiac outcomes than those without signs, and were more likely to have Low ⊕⊕⨀⨀ to Moderate
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