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Objective:
Cardiomyopathy (CMP) related heart failure (HF) with involvement of myocardium is a leading cause of disability and death. Using novel cardiac magnetic resonance imaging (CMR), late gadolinium enhancement (LGE) is detected as an imaging marker of myocardial fibrosis. Over the last few years there has been found increased percentage of ischemia related heart failure, subjecting patients to invasive catheter angiography for detection of coronary artery disease (CAD). This study evaluates role of Dual energy cardiac computed tomography (DECT) as a one-step modality to diagnose coronary artery disease and myocardial fibrosis in a single step investigation. To assess the diagnostic performance of Cardiac dual-energy CT in evaluation of myocardial delayed enhancement (MDE) with late gadolinium enhancement (LGE) MRI as the standard of reference.

Materials and Methods:
Thirty patients of heart failure with reduced ejection fraction (< 40%) who were diagnosed with myocardial scar (LGE) on CMR underwent DECT coronary angiography and delayed scan at 8 - 10 minute for assessment of MDE mainly assessing the coronary vascular status and myocardial delayed enhancement pattern detection. MDE images (Virtual monochromatic-VM and Iodine density maps) were compared with LGE images, with LGE as gold standard.

Results:
The diagnostic accuracy of Iodine density map and VM images as compared to LGE in CMR is 76% and 66% respectively. (<em>P</em> < 0.001). The sensitivity and specificity of virtual monochromatic images as compared to iodine density maps is 86.96% and 100% respectively, with Kappa value of 0.757 consistent with statistically significant result.

Conclusion:
Dual energy CT angiography with MDE is a robust investigation to detect coronary artery disease and myocardial fibrosis and can be used in evaluating heart failure patients especially where MRI is contraindicated.