[Influence of image quality on the diagnostic accuracy of dobutamine stress magnetic resonance imaging in comparison with dobutamine stress echocardiography for the noninvasive detection of myocardial ischemia].
The analysis of wall motion abnormalities with dobutamine stress echocardiography is an established method for the detection of myocardial ischemia. With ultrafast magnetic resonance tomography, the application of identical stress protocols as used for echocardiography is possible. In 208 consecutive patients (147 M, 61 F) with suspected coronary artery disease, dobutamine stress echocardiography partially using harmonic imaging and dobutamine stress magnetic resonance tomography (DSMR) were performed prior to cardiac catheterization. DSMR images were acquired during short breath holds in 3 short axis-, a 4-, and a 2-chamber view using a turbo 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 angiographic >/=50% diameter stenosis. With DSMR, significantly more patients yielded very good (69%) or good (13%) image quality in comparison with dobutamine stress echocardiography (20% and 31%, p<0. 05). Moderate image quality occurred in 16% with MR and 41% with dobutamine stress echocardiography (p<0.05), 2% and 8% were non-diagnostic. With each technique 18 patients could not be examined (DSE: emphysema: 10, adipositas: 8, DSMR: claustrophobia: 11, adipositas: 6, contraindication: 1). Four patients did not reach target heart rate. In 107 patients, significant coronary artery disease was found. With DSMR sensitivity was 88.7% (dobutamine stress echocardiography: 74.3%; p<0.05) and specificity 85.7% (dobutamine stress echocardiography: 69.8%; p <0.05). This difference was most pronounced in the group with moderate echocardiographic image quality. High dose DSMR is superior to dobutamine stress echocardiography and can replace this technique especially in patients with moderate echocardiographic image quality.
Nagel
E
E
Innere Medizin/Kardiologie, Deutsches Herzzentrum & Charité campus Virchow, Humboldt-Universität, Augustenburger Platz 1, D-13353 Berlin. eike.nagel@dhzb.de
Lehmkuhl
H B
HB
Klein
C
C
Schneider
U
U
Frantz
E
E
Ellmer
A
A
Bocksch
W
W
Dreysse
S
S
Fleck
E
E
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000175:diagnosis; D004280:Dobutamine; D004452:Echocardiography / Q000187:drug effects; D005080:Exercise Test / Q000187:drug effects; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D017202:Myocardial Ischemia / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D016277:Ventricular Function, Left / Q000187:drug effects
D002316:Cardiotonic Agents; D004280:Dobutamine