Prognostic value of negative dobutamine-stress cardiac magnetic resonance imaging.
BACKGROUND
Assessment of left ventricular wall motion during dobutamine-stress magnetic resonance (DSMR) is well established for the identification of myocardial ischemia. However, the integration of DSMR into the process of clinical decision-making in patients with suspected CAD is not well established. The aim of this study was to assess the value of DSMR used for clinical decision-making and to stratify the prognosis following this strategy.


METHODS
Medical records of 123 consecutive patients suspected of having CAD who underwent high-dose DSMR were reviewed and followed for a median of 23+/-12 months. DSMR results were used for decision-making, for example in favor of catheterization by the referring physician.


RESULTS
Thirty-four (27.6%) patients had inducible ischemia, of whom 31 (91.2%) underwent invasive angiography, 25 (80.6%) having stenoses of >50% in a vessel of > or =2 mm in diameter. Fifteen of these patients received vascularization (PCI/CABG); only two events (myocardial infarction) were observed during follow-up in this group. Eighty-nine (72.4%) patients had no inducible ischemia; 21 of them (23.6%) had invasive angiography resulting in 0 (0%) significant findings. In the remaining 68 (76.4%) patients with negative DSMR and who were not catheterized, an annual event rate of 0% was observed.


CONCLUSIONS
DSMR can be used for clinical decision-making in patients suspected of having CAD. This strategy results in a high prevalence of CAD in patients referred for invasive angiography due to a positive DSMR and an excellent prognosis in all patients with a negative DSMR.
Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany. kelle@dhzb.de
Sebastian
S
Kelle
Christina
C
Egnell
Juliane
J
Vierecke
Amedeo
A
Chiribiri
Susanne
S
Vogel
Eckart
E
Fleck
Eike
E
Nagel
D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D003710:Demography; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology; D011379:Prognosis