title: The additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress cardiac MRI for the detection of myocardial ischemia.
abstract: Purpose of this study was to assess the additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress Cardiac-MR (CMR). Dobutamine Stress CMR was performed in 115 patients with an inconclusive diagnosis of myocardial ischemia on a 1.5 T system (Magnetom Avanto, Siemens Medical Systems). Three short-axis cine and grid series were acquired during rest and at increasing doses of dobutamine (maximum 40 microg/kg/min). On peak dose dobutamine followed immediately by a first pass myocardial perfusion imaging sequence. Images were graded according to the sixteen-segment model, on a four point scale. Ninety-seven patients showed no New (Induced) Wall Motion Abnormalities (NWMA). Perfusion imaging showed absence of perfusion deficits in 67 of these patients (69%). Perfusion deficits attributable to known previous myocardial infarction were found in 30 patients (31%). Eighteen patients had NWMA, indicative for myocardial ischemia, of which 14 (78%) could be confirmed by a corresponding perfusion deficit. Four patients (22%) with NWMA did not have perfusion deficits. In these four patients NWMA were caused by a Left Bundle Branch Block (LBBB). They were free from cardiac events during the follow-up period (median 13.5 months; range 6-20). Addition of first-pass myocardial perfusion imaging during peak-dose dobutamine stress CMR can help to decide whether a NWMA is caused by myocardial ischemia or is due to an (inducible) LBBB, hereby preventing a false positive wall motion interpretation.
authors.affiliation: Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands. d.d.lubbers@rad.umcg.nl
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Lubbers
authors.forename: Caroline H C
authors.initials: CH
authors.lastname: Janssen
authors.forename: Dirkjan
authors.initials: D
authors.lastname: Kuijpers
authors.forename: Paul R M
authors.initials: PR
authors.lastname: van Dijkman
authors.forename: Jelle
authors.initials: J
authors.lastname: Overbosch
authors.forename: Tineke P
authors.initials: TP
authors.lastname: Willems
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
mesh_terms: D000318:Adrenergic beta-Agonists / Q000009:adverse effects; D000368:Aged; D002037:Bundle-Branch Block / Q000139:chemically induced / Q000473:pathology* / Q000503:physiopathology; D003326:Coronary Circulation; D004280:Dobutamine / Q000009:adverse effects; D005080:Exercise Test / Q000009:adverse effects / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000473:pathology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D016277:Ventricular Function, Left
chemical_list: D000318:Adrenergic beta-Agonists; D004280:Dobutamine