title: Small, short-duration, dobutamine-induced perfusion defects are not associated with adverse prognosis in intermediate-risk individuals receiving cardiovascular magnetic resonance stress imaging.
abstract: OBJECTIVE
  The objective of this study was to assess the frequency and prognostic utility of small, short-duration left ventricular myocardial perfusion defects during dobutamine cardiovascular magnetic resonance (DCMR) stress imaging.
  
  
  METHODS
  We performed first-pass contrast-enhanced DCMR at peak stress in 331 consecutively recruited individuals (aged 68 ± 8 years, 50% men) at intermediate risk for a future cardiac event. Size, location, and persistence of low-signal intensity perfusion defects were recorded. Cardiac events were assessed by personnel blinded to imaging results for a median of 24 months after the DCMR.
  
  
  RESULTS
  Among the 55 individuals (16.6%) who exhibited small (<25% myocardial thickness) and short-duration (<5 frames in persistence) perfusion defects, diabetes was more prevalent (P = 0.019) and no cardiac events were observed. Large, persistent perfusion defects were associated with coronary artery disease, prior myocardial infarction, and decreased left ventricular function (P < 0.001 for all) and increased 2-year risk for a cardiac event (hazard ratio, 10.3; P < 0.001; confidence interval, 3.3-33.0).
  
  
  CONCLUSIONS
  In individuals with diabetes, hypertension, or coronary artery disease at intermediate risk for a future cardiac event, small, short-duration DCMR perfusion defects are not associated with increased 2-year risk for a subsequent cardiac event.
authors.affiliation: From the Departments of *Internal Medicine (Section of Cardiology), †Biostatistical Sciences, ‡Biomedical Engineering, and §Radiology, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Jordan
authors.forename: Jason C
authors.initials: JC
authors.lastname: Haag
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Morgan
authors.forename: Sujethra
authors.initials: S
authors.lastname: Vasu
authors.forename: Brandon
authors.initials: B
authors.lastname: Stacey
authors.forename: Craig
authors.initials: C
authors.lastname: Hamilton
authors.forename: Killian
authors.initials: K
authors.lastname: Robinson
authors.forename: Dalane
authors.initials: D
authors.lastname: Kitzman
authors.forename: Vinay
authors.initials: V
authors.lastname: Thohan
authors.forename: William Gregory
authors.initials: WG
authors.lastname: Hundley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality*; D004280:Dobutamine; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004280:Dobutamine