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.
BACKGROUND
Some patients referred for pharmacological stress testing with transthoracic echocardiography (TTE) are unable to undergo testing owing to poor acoustic windows. Fast cine MRI can be used to assess left ventricular contraction, but its utility for detection of myocardial ischemia in patients poorly suited for echocardiography is unknown.


RESULTS
One hundred fifty-three patients (86 men and 67 women aged 30 to 88 years) with poor acoustic windows that prevented adequate second harmonic TTE imaging were consecutively referred for MRI to diagnose inducible myocardial ischemia during intravenous dobutamine and atropine. Diagnostic studies were completed in an average of 53 minutes. No patients experienced myocardial infarction, ventricular fibrillation, exacerbation of congestive heart failure, or death. In patients who underwent computer-assisted quantitative coronary angiography, the sensitivity and specificity for detecting a >50% luminal diameter narrowing were 83% and 83%, respectively. In the 103 patients with a negative MRI examination, the cardiovascular occurrence-free survival rate was 97%.


CONCLUSIONS
Fast cine cardiac MRI provides a mechanism to assess left ventricular contraction and diagnose inducible myocardial ischemia in patients not well suited for stress echocardiography.
Hundley
W G
WG
Cardiology Section, Division of Radiological Sciences, The Wake Forest University School of Medicine, Winston-Salem, NC, USA. ghundley@wfubmc.edu
Hamilton
C A
CA
Thomas
M S
MS
Herrington
D M
DM
Salido
T B
TB
Kitzman
D W
DW
Little
W C
WC
Link
K M
KM
D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001285:Atropine / Q000008:administration & dosage; D017023:Coronary Angiography; D018572:Disease-Free Survival; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography / Q000187:drug effects; D004562:Electrocardiography; D005080:Exercise Test / Q000009:adverse effects* / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D018579:Patient Selection
D000318:Adrenergic beta-Agonists; D004280:Dobutamine; D001285:Atropine