Prediction of regional functional recovery after acute myocardial infarction with low dose dobutamine stress cine MR imaging and contrast enhanced MR imaging.
OBJECTIVE
Previous studies demonstrated that low-dose dobutamine stress cine magnetic resonance imaging (MRI) and delayed contrast-enhanced MRI can provide assessments of myocardial viability. The purpose of this study was to evaluate the comparative diagnostic values of dobutamine cine MRI and delayed contrast-enhanced MRI for predicting functional recovery of myocardial contraction in patients with acute reperfused myocardial infarction.


METHODS
Twenty-three patients with myocardial infarction after percutaneous coronary interventions were studied. All patients underwent steady-state cine MRI covering the entire left ventricle at rest and during low-dose dobutamine stress (10 micrograms/kg/min). Delayed contrast-enhanced MR images were acquired to determine transmural extent of hyperenhancement. Second cine MR images in the resting state were obtained 3 to 11 months after revascularization.


RESULTS
On the first cine MR images in the resting state, 278 (20%) of 1380 segments demonstrated abnormal, regional contraction (systolic wall thickening < 40%). Of the 175 segments showing functional recovery on the following cine MRI, 156 (89%) segments were recognized as reversible by dobutamine cine MRI and 146 (83%) segments by delayed contrast-enhanced MRI. The sensitivity, specificity, and accuracy of dobutamine stress cine MRI was 89%, 80%, and 86%, respectively. These values of contrast-enhanced MRI were 83%, 72%, and 79%, respectively. The area under the receiver operating curve (ROC) was 0.87 by dobutamine cine MRI and 0.78 by delayed contrast-enhanced MRI (p < 0.05).


CONCLUSIONS
The current results using quantitative segmental analysis indicated that low-dose dobutamine stress cine MRI can predict recovery of myocardial contractility with significantly higher diagnostic performance in comparison with contrast-enhanced MRI in patients with myocardial infarction who underwent revascularization.
Motoyasu
Munenobu
M
First Department of Internal Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan. motoyasu@clin.medic.mie-u.ac.jp
Sakuma
Hajime
H
Ichikawa
Yasutaka
Y
Ishida
Nanaka
N
Uemura
Shoko
S
Okinaka
Tsutomu
T
Isaka
Naoki
N
Takeda
Kan
K
Nakano
Takeshi
T
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents; D003287:Contrast Media; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D012372:ROC Curve; D020127:Recovery of Function / Q000502:physiology; D012146:Rest / Q000502:physiology; D012680:Sensitivity and Specificity
D002316:Cardiotonic Agents; D003287:Contrast Media; D004280:Dobutamine; D019786:Gadolinium DTPA