Comparison of Dobutamine Stress Magnetic Resonance, Adenosine Stress Magnetic Resonance, and Adenosine Stress Magnetic Resonance Perfusion

Abstract

Background-Dobutamine stress MR (DSMR) is highly accurate for the detection of inducible wall motion abnormalities (IWMAs). Adenosine has a more favorable safety profile and is well established for the assessment of myocardial perfusion. We evaluated the diagnostic value of IWMAs during dobutamine and adenosine stress MR and adenosine MR perfusion compared with invasive coronary angiography. Methods and Results-Seventy-nine consecutive patients (suspected or known coronary disease, no history of prior myocardial infarction) scheduled for cardiac catheterization underwent cardiac MR (1.5 T). After 4 minutes of adenosine infusion (140 g · kg Ϫ1 · min Ϫ1 for 6 minutes), wall motion was assessed (steady-state free precession), and subsequently perfusion scans (3-slice turbo field echo-echo planar imaging; 0.05 mmol/kg Gd-BOPTA) were performed. After a 15-minute break, rest perfusion was imaged, followed by standard DSMR/atropine stress MR. Wall motion was classified as pathological if Ն1 segment showed IWMAs. The transmural extent of inducible perfusion deficits (Ͻ25%, 25% to 50%, 51% to 75%, and Ͼ75%) was used to grade segmental perfusion. Quantitative coronary angiography was performed with significant stenosis defined as Ͼ50% diameter stenosis. Fifty-three patients (67%) had coronary artery stenoses Ͼ50%; sensitivity and specificity for detection by dobutamine and adenosine stress and adenosine perfusion were 89% and 80%, 40% and 96%, and 91% and 62%, respectively. Adenosine IWMAs were seen only in segments with Ͼ75% transmural perfusion deficit. Conclusions-DSMR is superior to adenosine stress for the induction of IWMAs in patients with significant coronary artery disease. Visual assessment of adenosine stress perfusion is sensitive with a low specificity, whereas adenosine stress MR wall motion is highly specific because it identifies only patients with high-grade perfusion deficits. Thus, DSMR is the method of choice for current state-of-the-art treatment regimens to detect ischemia in patients with suspected or known coronary artery disease but no history of prior myocardial infarction.

The Prognostic Value of Normal Stress Cardiovascular Magnetic Resonance Imaging

“…The later development of wall motion abnormalities in this sequence suggests that stress p-MRI may be more sensitive in detecting CAD, and therefore more useful for prognosis than stress cine MRI. In diagnostic opportunities, several authors suggested that perfusion markers are more sensitive and wall motion abnormalities more specific for the detection of CAD [26,27]. In comparing the predictive power of positive stress test results, adenosine perfusion and dobutamine wall motion imaging were equally high [6].…”

The Role of Cardiac MRI In Coronary Heart Disease Management

“…Following acute MI, cine CMR with low-dose dobutamine can be used to assess viability (69) . Highdose dobutamine stress CMR has high predictive value in identifying LV wall motion abnormalities due to coronary stenosis (70) .…”

The emerging clinical role of cardiovascular magnetic resonance imaging

“…It is commonly believed that adenosine causes a 'steal phenomenon' by increasing perfusion in coronary territories not affected by epicardial artery stenosis, which leads to relative hypoperfusion of the territory subtended by a stenosed coronary artery (33). Several research papers (34)(35)(36)(37)(38), including one multicentre study, have assessed the role of adenosine stress perfusion for the diagnosis of coronary artery disease and consistently demonstrated high sensitivity for CMR imaging to diagnose epicardial coronary artery stenoses. When CMR perfusion was compared with x-ray coronary angiography, its specificities to detect coronary stenoses were only moderately high (62% to 90%) (34)(35)(36)(37)(38).…”

“…Several research papers (34)(35)(36)(37)(38), including one multicentre study, have assessed the role of adenosine stress perfusion for the diagnosis of coronary artery disease and consistently demonstrated high sensitivity for CMR imaging to diagnose epicardial coronary artery stenoses. When CMR perfusion was compared with x-ray coronary angiography, its specificities to detect coronary stenoses were only moderately high (62% to 90%) (34)(35)(36)(37)(38). However, when PET or fractional flow reserve on x-ray angiography were used as standards of truth, specificities were higher (94% [34] and 90% [38], respectively).…”