title: Prognostic value of high-dose dobutamine stress magnetic resonance imaging in 1,493 consecutive patients: assessment of myocardial wall motion and perfusion.
abstract: OBJECTIVE
  This study sought to determine the prognostic value of wall motion and perfusion assessment during high-dose dobutamine stress (DS) cardiac magnetic resonance imaging (MRI) in a large patient cohort.
  
  
  BACKGROUND
  DS-MRI offers the possibility to integrate myocardial perfusion and wall motion analysis in a single examination for the detection of coronary artery disease (CAD).
  
  
  METHODS
  A total of 1,493 consecutive patients with suspected or known CAD underwent DS-MRI, using a standard protocol in a 1.5-T magnetic resonance scanner. Wall motion and perfusion were assessed at baseline and during stress, and outcome data including cardiac death, nonfatal myocardial infarction ("hard events"), and "late" revascularization performed >90 days after the MR scans were collected during a 2 ± 1 year follow-up period.
  
  
  RESULTS
  Fifty-three hard events, including 14 cardiac deaths and 39 nonfatal infarctions, occurred during the follow-up period, whereas 85 patients underwent "late" revascularization. Using multivariable regression analysis, an abnormal result for wall motion or perfusion during stress yielded the strongest independent prognostic value for both hard events and late revascularization, clearly surpassing that of clinical and baseline magnetic resonance parameters (for wall motion: adjusted hazard ratio [HR] of 5.9 [95% confidence interval (CI): 2.5 to 13.6] for hard events and of 3.1 [95% CI: 1.7 to 5.6] for late revascularization, and for perfusion: adjusted HR of 5.4 [95% CI: 2.3 to 12.9] for hard events and of 6.2 [95% CI: 3.3 to 11.3] for late revascularization, p < 0.001 for all).
  
  
  CONCLUSIONS
  DS-MRI can accurately identify patients who are at increased risk for cardiac death and myocardial infarction, separating them from those with normal findings, who have very low risk for future cardiac events. (Prognostic Value of High Dose Dobutamine Stress Magnetic Resonance Imaging; NCT00837005).
authors.affiliation: Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, Germany. gkorosoglou@hotmail.com
authors.forename: Grigorios
authors.initials: G
authors.lastname: Korosoglou
authors.forename: Yacine
authors.initials: Y
authors.lastname: Elhmidi
authors.forename: Henning
authors.initials: H
authors.lastname: Steen
authors.forename: Dieter
authors.initials: D
authors.lastname: Schellberg
authors.forename: Nina
authors.initials: N
authors.lastname: Riedle
authors.forename: Johannes
authors.initials: J
authors.lastname: Ahrens
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lehrke
authors.forename: Constanze
authors.initials: C
authors.lastname: Merten
authors.forename: Dirk
authors.initials: D
authors.lastname: Lossnitzer
authors.forename: Jannis
authors.initials: J
authors.lastname: Radeleff
authors.forename: Christian
authors.initials: C
authors.lastname: Zugck
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology*; D004280:Dobutamine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005080:Exercise Test / Q000187:drug effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D004280:Dobutamine