Dobutamine cardiac magnetic resonance results predict cardiac prognosis in women with known or suspected ischemic heart disease.
OBJECTIVE
The purpose of this study was to determine the prognostic utility of dobutamine cardiac magnetic resonance (DCMR) stress test results in women.


BACKGROUND
To date, the preponderance of studies reporting the utility of DCMR stress results for predicting cardiac prognosis have been performed in men. We sought to determine the utility of DCMR results for predicting cardiac prognosis in women.


METHODS
Two hundred sixty-six consecutively referred women underwent DCMR in which left ventricular wall motion (LVWM) was assessed at rest and after intravenous dobutamine and atropine. Inducible LVWM abnormalities were identified during testing. Women were contacted to determine the post-DCMR occurrence of a cardiac event. All events were substantiated according to defined criteria and then were verified after a thorough medical record review by individuals blinded to testing data.


RESULTS
Women were contacted an average of 6.2 +/- 1.6 (median 6.2, range 0.8 to 10.4) years after DCMR; 27% of the women experienced an inducible LVWM abnormality during testing. In those with and without inducible LVWM abnormalities, the proportion of women with cardiac events were 63% versus 30%, respectively, (hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.8 to 4.3 for the presence of inducible LVWM abnormalities p < 0.0001). The proportion of women with myocardial infarction (MI) and cardiac death were 33.3% and 7.5%, respectively. This resulted in a HR for MI and cardiac death of 4.1 (95% CI: 2.2 to 9.4) for those with versus those without inducible LVWM abnormalities; p < 0.0001. A subgroup analysis was performed in women without a history of coronary artery disease and in those with LVWM abnormalities, DCMR remained an adverse predictor of cardiac events (HR: 4.0, 95% CI: 1.8 to 9.0, p = 0.003).


CONCLUSIONS
Inducible LVWM abnormalities during DCMR predict cardiac death and MI in women. Similar to men, these results indicate that DCMR is a valuable noninvasive stress imaging modality for identifying cardiac risk in women with known or suspected ischemic heart disease.
Wallace
Eric L
EL
Department of Internal Medicine (Cardiology Section), Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.
Morgan
Timothy M
TM
Walsh
Thomas F
TF
Dall'Armellina
Erica
E
Ntim
William
W
Hamilton
Craig A
CA
Hundley
W Gregory
WG
D000368:Aged; D001285:Atropine; D002316:Cardiotonic Agents; D004280:Dobutamine; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016277:Ventricular Function, Left; D014932:Women's Health Services
D002316:Cardiotonic Agents; D004280:Dobutamine; D001285:Atropine