title: The role of dobutamine stress cardiovascular magnetic resonance in the clinical management of patients with suspected and known coronary artery disease.
abstract: BACKGROUND
  Recent studies have demonstrated the consistently high diagnostic and prognostic value of dobutamine stress cardiovascular magnetic resonance (DCMR). The value of DCMR for clinical decision making still needs to be defined. Hence, the purpose of this study was to assess the utility of DCMR regarding clinical management of patients with suspected and known coronary artery disease (CAD) in a routine setting.
  
  
  RESULTS
  We prospectively performed a standard DCMR examination in 1532 consecutive patients with suspected and known CAD. Patients were stratified according to the results of DCMR: DCMR-positive patients were recommended to undergo invasive coronary angiography and DCMR-negative patients received optimal medical treatment. Of 609 (40%) DCMR-positive patients coronary angiography was performed in 478 (78%) within 90 days. In 409 of these patients significant coronary stenoses ≥ 50% were present (positive predictive value 86%). Of 923 (60%) DCMR-negative patients 833 (90%) received optimal medical therapy. During a mean follow-up period of 2.1 ± 0.8 years (median: 2.1 years, interquartile range 1.5 to 2.7 years) 8 DCMR-negative patients (0.96%) sustained a cardiac event.In 131 DCMR-positive patients who did not undergo invasive angiography, 20 patients (15%) suffered cardiac events. In 90 DCMR-negative patients (10%) invasive angiography was performed within 2 years (range 0.01 to 2.0 years) with 56 patients having coronary stenoses ≥ 50%.
  
  
  CONCLUSIONS
  In a routine setting DCMR proved a useful arbiter for clinical decision making and exhibited high utility for stratification and clinical management of patients with suspected and known CAD.
authors.affiliation: German Heart Institute Berlin, Germany. gebker@dhzb.de
authors.forename: Rolf
authors.initials: R
authors.lastname: Gebker
authors.forename: Cosima
authors.initials: C
authors.lastname: Jahnke
authors.forename: Robert
authors.initials: R
authors.lastname: Manka
authors.forename: Thomas
authors.initials: T
authors.lastname: Hucko
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schnackenburg
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kelle
authors.forename: Christoph
authors.initials: C
authors.lastname: Klein
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.forename: Ingo
authors.initials: I
authors.lastname: Paetsch
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents; D002317:Cardiovascular Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000188:drug therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D004280:Dobutamine; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D004280:Dobutamine