Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography.
BACKGROUND
The analysis of wall motion abnormalities with dobutamine stress echocardiography (DSE) is an established method for the detection of myocardial ischemia. With ultrafast magnetic resonance tomography, identical stress protocols as used for echocardiography can be applied.


RESULTS
In 208 consecutive patients (147 men, 61 women) with suspected coronary artery disease, DSE with harmonic imaging and dobutamine stress magnetic resonance (DSMR) (1.5 T) were performed before cardiac catheterization. DSMR images were acquired during short breath-holds in 3 short-axis views and a 4- and a 2-chamber view (gradient echo technique). Patients were examined at rest and during a standard dobutamine-atropine scheme until submaximal heart rate was reached. Regional wall motion was assessed in a 16-segment model. Significant coronary heart disease was defined as >/=50% diameter stenosis. Eighteen patients could not be examined by DSMR (claustrophobia 11 and adipositas 6) and 18 patients by DSE (poor image quality). Four patients did not reach target heart rate. In 107 patients, coronary artery disease was found. With DSMR, sensitivity was increased from 74.3% to 86.2% and specificity from 69.8% to 85.7% (both P<0.05) compared with DSE. Analysis for women yielded similar results.


CONCLUSIONS
High-dose dobutamine magnetic resonance tomography can be performed with a standard dobutamine/atropine stress protocol. Detection of wall motion abnormalities by DSMR yields a significantly higher diagnostic accuracy in comparison to DSE.
Nagel
E
E
Department of Internal Medicine/Cardiology, German Heart Institute and Charité Campus Virchow, Humboldt University, Berlin, Germany. eike.nagel@charite.de
Lehmkuhl
H B
HB
Bocksch
W
W
Klein
C
C
Vogel
U
U
Frantz
E
E
Ellmer
A
A
Dreysse
S
S
Fleck
E
E
D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography / Q000379:methods* / Q000592:standards; D005080:Exercise Test / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D012680:Sensitivity and Specificity