Head to head comparison of dobutamine-transoesophageal echocardiography and dobutamine-magnetic resonance imaging for the prediction of left ventricular functional recovery in patients with chronic coronary artery disease.
OBJECTIVE
A substantial number of patients with dysfunctional but potentially viable myocardium cannot be accurately evaluated by transthoracic echocardiography due to a poor acoustic window. This study compares the diagnostic value of alternative functional imaging techniques, such as dobutamine-transoesophageal echocardiography (dobutamine-TEE) and dobutamine magnetic resonance imaging (dobutamine-MRI) for the detection of viable myocardium and the prediction of left ventricular functional recovery in patients with chronic coronary artery disease following successful revascularization procedures.


RESULTS
Rest and low-dose (5, 10 microg dobutamine x min(-1) x kg(-1)) multiplane dobutamine-TEE and ultrafast cine-MRI studies were performed in 103 patients. Contractile recovery of an infarct region was predicted if a dobutamine contraction reserve could be assessed visually by TEE or MRI in > or =50% of infarct-related a- or dyskinetic segments. Revascularization of the infarct-related vessel was successful in 88 patients, and 4.9 +/- 0.7 months later 52 patients still had an angiographically controlled open target vessel. These patients underwent another rest MRI study to assess left ventricular functional recovery. A dobutamine contraction reserve was observed in 27/52 (52%) patients by TEE and in 26/52 (50%) patients by MRI. Functional improvement of the infarct region was diagnosed in 28/52 (54%) patients. The positive and negative predictive accuracy of dobutamine-TEE and dobutamine-MRI for the prediction of left ventricular functional recovery was not significantly different (85% vs 92%, ns and 80% vs 85%, ns). Diagnosis of a predominantly viable infarct region by TEE and MRI predicted a significant increase in left ventricular ejection fraction (TEE: 12 +/- 8% vs 2 +/- 7% P<0.001, MRI: 13 +/- 7% vs 2 +/- 7%, P<0.001) compared to infarct regions graded as scar.


CONCLUSIONS
A qualitative visual analysis of TEE and MRI viability studies is highly accurate for the prediction of left ventricular functional recovery in patients with dysfunctional myocardium and proved to be a clinically valuable alternative if transthoracic dobutamine-echocardiography is unsuitable. To date, TEE is cardiologists' preferred choice for the assessment of myocardial viability but MRI may become significantly more attractive with increasing local availability and experience.
Baer
F M
FM
Klinik III für Innere Medizin, der Universität zu Köln, Germany.
Theissen
P
P
Crnac
J
J
Schmidt
M
M
Deutsch
H J
HJ
Sechtem
U
U
Schicha
H
H
Erdmann
E
E
D000368:Aged; D002908:Chronic Disease; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D004280:Dobutamine; D017548:Echocardiography, Transesophageal; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009204:Myocardial Revascularization; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume; D016277:Ventricular Function, Left
D004280:Dobutamine