title: Long-term prognostic value of dobutamine stress CMR.
abstract: OBJECTIVE
  The aim of this study was to assess the long-term value of high-dose dobutamine cardiac magnetic resonance (DCMR) for the prediction of cardiac events in a large cohort of patients with known or suspected coronary artery disease.
  
  
  BACKGROUND
  High-dose DCMR has been shown to be a useful technique for diagnosis and intermediate-term prognostic stratification.
  
  
  METHODS
  Clinical data and DCMR results were analyzed in 1,463 consecutive patients undergoing DCMR between 2000 and 2004. Ninety-four patients were lost to follow-up. The remaining 1,369 patients were followed up for a mean of 44 ± 24 months. Cardiac events, defined as cardiac death and nonfatal myocardial infarction, were related to clinical and DCMR results.
  
  
  RESULTS
  Three-hundred fifty-two patients underwent early revascularization (≤ 3 months of DCMR) and were excluded from analysis. Of the remaining 1,017 patients, 301 patients (29.6%) experienced inducible wall motion abnormalities (WMA). Forty-six cardiac events were reported. In those with and without inducible WMA, the proportion of patients with cardiac events was 8.0% versus 3.1%, respectively, p = 0.001 (hazard ratio: 3.3; 95% confidence interval: 1.8 to 5.9 for the presence of inducible WMA; p < 0.001). A DCMR without inducible WMA carried an excellent prognosis, with a 6-year cardiac event-free survival of 96.8%. In all 1,369 patients in the patient group with stress-inducible WMA, those patients with medical therapy demonstrated a trend to a higher cardiac event rate (8.0%) than those with early revascularization (5.4%) (p = 0.234). Patients with normal DCMR and medical therapy or early revascularization demonstrated similar cumulative cardiac event rates (3.1% vs. 3.2%, p = 0.964).
  
  
  CONCLUSIONS
  In a large cohort of patients, DCMR has an added value for predicting cardiac events during long-term follow-up, improving the differentiation between high-risk and low-risk patients. Patients with inducible WMA and following early revascularization, demonstrate lower cardiac event rates than patients with medical therapy alone.
authors.affiliation: Department of Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. kelle@dhzb.de
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kelle
authors.forename: Amedeo
authors.initials: A
authors.lastname: Chiribiri
authors.forename: Juliane
authors.initials: J
authors.lastname: Vierecke
authors.forename: Christina
authors.initials: C
authors.lastname: Egnell
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamdan
authors.forename: Cosima
authors.initials: C
authors.lastname: Jahnke
authors.forename: Ingo
authors.initials: I
authors.lastname: Paetsch
authors.forename: Ernst
authors.initials: E
authors.lastname: Wellnhofer
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.forename: Christoph
authors.initials: C
authors.lastname: Klein
authors.forename: Rolf
authors.initials: R
authors.lastname: Gebker
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D018572:Disease-Free Survival; D004280:Dobutamine; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D004280:Dobutamine