title: Prediction of cardiac events in patients with reduced left ventricular ejection fraction with dobutamine cardiovascular magnetic resonance assessment of wall motion score index.
abstract: OBJECTIVE
  The purpose of this study was to assess the utility of dobutamine cardiovascular magnetic resonance (DCMR) results for predicting cardiac events in individuals with reduced left ventricular ejection fraction (LVEF).
  
  
  BACKGROUND
  It is unknown whether DCMR results identify a poor cardiac prognosis when the resting LVEF is moderately to severely reduced.
  
  
  METHODS
  Two hundred consecutive patients ages 30 to 88 (average 64) years with an LVEF <or=55% that were poorly suited for stress echocardiography underwent DCMR in which left ventricular wall motion score index (WMSI), defined as the average wall motion of the number of segments scored, was assessed at rest, during low-dose, and after peak intravenous infusion of dobutamine/atropine. All participants were followed for an average of 5 years after DCMR to ascertain the post-testing occurrence of cardiac death, myocardial infarction (MI), and unstable angina or congestive heart failure warranting hospital stay.
  
  
  RESULTS
  After accounting for risk factors associated with coronary arteriosclerosis and MI, a stress-induced increase in WMSI during DCMR was associated with future cardiac events (p < 0.001). A DCMR stress-induced change in WMSI added significantly to predicting future cardiac events (p = 0.003), after accounting for resting LVEF, but this predictive value was confined primarily to those with an LVEF >40%.
  
  
  CONCLUSIONS
  In individuals with mild to moderate reductions in LVEF (40% to 55%), dobutamine-induced increases in WMSI forecast MI and cardiac death to a greater extent than an assessment of resting LVEF. In those with an LVEF <40%, a dobutamine-induced increase in WMSI does not predict MI and cardiac death beyond the assessment of resting LVEF.
authors.affiliation: Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Dall'Armellina
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Morgan
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mandapaka
authors.forename: William
authors.initials: W
authors.lastname: Ntim
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.forename: Craig A
authors.initials: CA
authors.lastname: Hamilton
authors.forename: John
authors.initials: J
authors.lastname: Hoyle
authors.forename: Hollins
authors.initials: H
authors.lastname: Clark
authors.forename: Paige
authors.initials: P
authors.lastname: Clark
authors.forename: Kerry M
authors.initials: KM
authors.lastname: Link
authors.forename: Doug
authors.initials: D
authors.lastname: Case
authors.forename: W Gregory
authors.initials: WG
authors.lastname: Hundley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D025401:Echocardiography, Stress; D005260:Female; D006352:Heart Ventricles / Q000187:drug effects / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects