Abstract
The aim of this study was to determine the prognostic value of dobutamine cardiovascular magnetic resonance (CMR) in patients suspected of myocardial ischemia. Clinical data and dobutamine-CMR results were analyzed in 299 consecutive patients. Follow-up data were analyzed in categories of risk levels defined by the history of coronary artery disease and presence of rest wall motion abnormalities (RWMA). Major adverse cardiac events (MACE) as evaluated end points included cardiac death, nonfatal myocardial infarction and clinically indicated coronary revascularization. Follow-up was completed in 214 (99%) patients with a negative dobutamine-CMR study (no signs of inducible myocardial ischemia) with an average of 24 months. The patients with a negative dobutamine-CMR study and RWMA showed a significantly higher annual MACE rate (18%) than the patients without RWMA (0.56%) (P<0.001). Patients without RWMA showed an annual MACE rate of 2% when they had a history of coronary artery disease and <0.1% without a previous coronary event (P<0.001). Dobutamine-CMR showed a positive and negative predictive value of 95 and 93%, respectively. The cardiovascular occurrence-free survival rate was 96.2%. In patients suspected of myocardial ischemia, dobutamine-CMR is able to assess risk levels for coronary events with high accuracy.
References
American Heart Association, American College of Cardiology (1997) Guidelines for exercise testing. J Am Coll Cardiol 30:260–315
American Heart Association, American College of Cardiology (2002) Guideline update for exercise testing. Circulation 106:1883–1892
American Heart Association, American College of Cardiology (1999) Guidelines for coronary angiography. J Am Coll Cardiol 33:1756–1824
Mark DB, Shaw L, Harrell FE Jr, Hlatky MA, Lee KL, Bengtson JR, McCants CB, Califf RM, Pryor DB (1991) Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med 325:849–853
Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, Diamond GA (1996) Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation 93:905–914
Pennell DJ, Underwood SR, Manzara CC, Swanton RH, Walker JM, Ell PJ, Longmore DB (1992) Magnetic resonance imaging during dobutamine stress in coronary artery disease. Am J Cardiol 70:34–40
Nagel E, Lehmkuhl HB, Bocksch W, Klein C, Vogel U, Frantz E, Ellmer A, Dreysse S, Fleck E (1999) Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation 99:763–770
Hundley WG, Hamilton CA, Thomas MS, Herrington DM, Salido TB, Kitzman DW, Little WC, Link KM (1999) Utility of fast cine magnetic resonance imaging and display for the detection of myocardial ischemia in patients not well suited for second harmonic stress echocardiography. Circulation 100:1697–1702
Kuijpers D, Ho KYJAM, Dijkman PRM van, Vliegenthart R, Oudkerk M (2003) Dobutamine cardiovascular magnetic resonance for the detection of myocardial ischemia using myocardial tagging. Circulation 107:1592–1597
Hundley WG, Morgan TM, Neagle CM, Hamilton CA, Rerkpattanapipat P, Link KM (2002) Magnetic Resonance Imaging determination of cardiac prognosis. Circulation 106:2328–2333
Henry WL, DeMaria A, Gramiak R, King DL, Kisslo JA, Popp RL, Sahn DJ, Schiller NB, Tajik A, Teichholz LE, Weyman AE (1980) Report of the American Society of echocardiography committee on nomenclature and standards in two-dimensional echocardiography. Circulation 62:212–215
Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ Jr, Cuddy TE, Davis BR, Geltman EM, Goldman S, Flaker GC (1992) Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 327:669–677
Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo IM (1990) Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med 323:1781–1788
Poldermans D, Fioretti PM, Boersma E, Bax JJ, Thomson IR, Roelandt JRTC, Simoons ML (1999) Long term prognostic value of dobutamine-atropine stress echocardiography in 1737 patients with known or suspected coronary artery disease. A single center experience. Circulation 99:757–762
Kannel WB, Abbott RD (1984) Incidence and prognosis of unrecognized myocardial infarction: an update on the Framingham study. N Engl J Med 311:1144–1147
Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM (2000) The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 343:1445–1453
Wagner A, Mahrholdt H, Holly TA, Elliott MD, Regenfus M, Parker M, Klocke FJ, Bonow RO, Kim RJ, Judd RM (2003) Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet 361:374–379
Achenbach S, Daniel WG (2001) Noninvasive coronary angiography: an acceptable alternative? N Engl J Med 345:1909–1910
Greenland P, Gaziano JM (2003) Selecting asymptomatic patients for coronary computed tomography or electrocardiographic exercise testing. N Engl J Med 349:465–473
Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (2001) Executive summary of the third report of the national cholesterol education program (NCEP). J Am Med Assoc 285:2486–2497
Elhendy A, van Domburg RT, Bax JJ, Nierop PR, Geleijnse ML, Ibrahim MM, Roelandt JRTC (1999) The functional significance of chronotropic incompetence during dobutamine-stress test. Heart 81:398–403
Nagel E, Klein C, Paetsch I, Hettwer S, Schnackenburg B, Wegscheider K, Fleck E (2003) Magnetic resonance perfusion measurements for the noninvasive detection of coronary artery disease. Circulation 108:432–437
Klein C, Nekolla SG, Bengel FM, Momose M, Sammer A, Haas F, Schnackenburg B, Delius W, Mudra H, Wolfram D, Schwaiger M (2002) Assessment of myocardial viability with contrast-enhanced magnetic resonance imaging: comparison with positron emission tomography. Circulation 105:162–166
Ibrahim T, Nekolla SG, Schreiber K, Odaka K, Volz S, Mehilli J, Guthlin M, Delius W, Schwaiger M (2002) Assessment of coronary flow reserve: comparison between contrast-enhanced magnetic resonance imaging and positron emission tomography. J Am Coll Cardiol 39:864–870
Bogaert J, Maes A, Van de Werf F, Bosmans H, Herregods MC, Nuyts J, Desmet W, Mortelmans L, Marchal G, Rademakers FE (1999) Functional recovery of subepicardial myocardial tissue in transmural myocardial infarction after successful reperfusion: an important contribution to the improvement of regional and global left ventricular function. Circulation 99:36–43
Lipton MJ, Bogaert J, Boxt LM, Reba RC (2002) Imaging of ischemic heart disease. Eur Radiol 12:1061–1080
Sandstede JJ (2003) Assessment of myocardial viability by MR imaging. Eur Radiol 13:52–61
Dewey M, Borges AC, Kivelitz D, Taupitz M, Wagner S, Baumann G, Hamm B (2004) Coronary artery disease: new insights and their implications for radiology. Eur Radiol 14:1048–1054
Panting JR, Gatehouse PD, Yang GZ, Grothues F, Firmin DN, Collins P, Pennell DJ (2002) Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging. N Engl J Med 346:1948–1953
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We are indebted to Dr. W.J. Post for data analysis.
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Kuijpers, D., van Dijkman, P.R.M., Janssen, C.H.C. et al. Dobutamine stress MRI. Part II. Risk stratification with dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia. Eur Radiol 14, 2046–2052 (2004). https://doi.org/10.1007/s00330-004-2426-x
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DOI: https://doi.org/10.1007/s00330-004-2426-x