The additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress cardiac MRI for the detection of myocardial ischemia.
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.
Lubbers
Daniel D
DD
Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands. d.d.lubbers@rad.umcg.nl
Janssen
Caroline H C
CH
Kuijpers
Dirkjan
D
van Dijkman
Paul R M
PR
Overbosch
Jelle
J
Willems
Tineke P
TP
Oudkerk
Matthijs
M
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
D000318:Adrenergic beta-Agonists; D004280:Dobutamine