Head-to-head comparison between contrast-enhanced magnetic resonance imaging and dobutamine magnetic resonance imaging in men with ischemic cardiomyopathy.
Contrast-enhanced magnetic resonance imaging (MRI) can predict functional recovery after revascularization. Segments with small, subendocardial scars have a large likelihood of recovery, and segments with transmural infarction have a small likelihood of recovery. Segments with an intermediate extent of infarction have an intermediate likelihood of recovery, and therefore, additional information is needed. Accordingly, the transmurality of infarction on contrast-enhanced MRI was compared with low-dose dobutamine MRI to further define viability in 48 patients. Regional contractile dysfunction was determined by cine MRI at rest (17-segment model), and contractile reserve was determined using low-dose dobutamine infusion. Contrast-enhanced MRI was performed to assess the extent of scar tissue. A total of 338 segments (41%) were dysfunctional, with 61% having contractile reserve. Most segments (approximately 75%) with small, subendocardial scars (hyperenhancement scores 1 or 2) had contractile reserve, whereas contractile reserve was not frequently (17%) observed in segments with transmural infarction (hyperenhancement score 4) (p <0.05). Of segments with an intermediate infarct transmurality (hyperenhancement score 3), contractile reserve was observed in 42%, whereas 58% did not have contractile reserve. In conclusion, the agreement between contrast-enhanced MRI and low-dose dobutamine MRI is large in the extremes (subendocardial scars and transmural scars), and contrast-enhanced MRI may be sufficient to assess the likelihood of the recovery of function after revascularization. However, 61% of segments with an intermediate extent of scar tissue on MRI have contractile reserve and 39% lack contractile reserve. In these segments, low-dose dobutamine MRI may be needed to optimally differentiate myocardium with large and small likelihoods of functional recovery after revascularization.
Kaandorp
Theodorus A M
TA
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. T.A.M.kaandorp@lumc.nl
Bax
Jeroen J
JJ
Schuijf
Joanne D
JD
Viergever
Eric P
EP
van Der Wall
Ernst E
EE
de Roos
Albert
A
Lamb
Hildo J
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents; D002921:Cicatrix / Q000209:etiology / Q000473:pathology; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000473:pathology*; D004280:Dobutamine; D006801:Humans; D018476:Hypokinesia / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology; D018487:Ventricular Dysfunction, Left / Q000473:pathology* / Q000503:physiopathology
D002316:Cardiotonic Agents; D003287:Contrast Media; D004280:Dobutamine