Dobutamine stress MRI. Part II. Risk stratification with dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia

Abstract

The aim of this study was to determine the prognostic value of dobutamine cardiovascular magnetic resonance (CMR) in patients suspected of myocardial ischemia. Clinical data and dobutamine-CMR results were analyzed in 299 consecutive patients. Follow-up data were analyzed in categories of risk levels defined by the history of coronary artery disease and presence of rest wall motion abnormalities (RWMA). Major adverse cardiac events (MACE) as evaluated end points included cardiac death, nonfatal myocardial infarction and clinically indicated coronary revascularization. Follow-up was completed in 214 (99%) patients with a negative dobutamine-CMR study (no signs of inducible myocardial ischemia) with an average of 24 months. The patients with a negative dobutamine-CMR study and RWMA showed a significantly higher annual MACE rate (18%) than the patients without RWMA (0.56%) ( P<0.001). Patients without RWMA showed an annual MACE rate of 2% when they had a history of coronary artery disease and <0.1% without a previous coronary event ( P<0.001). Dobutamine-CMR showed a positive and negative predictive value of 95 and 93%, respectively. The cardiovascular occurrence-free survival rate was 96.2%. In patients suspected of myocardial ischemia, dobutamine-CMR is able to assess risk levels for coronary events with high accuracy.

The Prognostic Value of Normal Stress Cardiovascular Magnetic Resonance Imaging

“…2. Eventually, 11 studies [5,6,8,[18][19][20][21][22][23][24][25] fulfilled all inclusion criteria and were eligible for meta-analysis. All eligible studies had been published in peer-reviewed journals between 2004 and 2011.…”

“…These patients were followed for 0.8 to 6.2 years (Table 1). For prognostic utility, six studies evaluated stress cine MRI [5,6,8,19,[21][22] and seven studies evaluated stress p-MRI [6,18,20,[22][23][24][25]. Three studies evaluated both stress cine MRI and stress p-MRI in the same patient groups [6,21,22].…”

“…Three studies evaluated both stress cine MRI and stress p-MRI in the same patient groups [6,21,22]. Five studies reported data on both hard cardiac events and MACE [5,6,8,18,23], three studies hard cardiac events only [19,22,24], and three studies MACE only [20,21,25]. Methodological quality assessment by NOS was 5-6 stars (Table 1).…”

“…Against this background, reports on the evaluation of coronary artery disease (CAD) and prognosis of patients suspected of having CAD by CMR have been increasing [1][2][3][4]. Recently, several prognostic studies with various follow-up periods using CMR have been reported [5][6][7][8]. Prognostic information is useful in cardiac risk stratification and subsequent clinical management.…”

The emerging clinical role of cardiovascular magnetic resonance imaging

“…Dobutamine stress studies for ischemia-induced wall motion abnormalities can be performed with CMR protocols identical to those established for transthoracic dobutamine stress echocardiography, with a similar safety profile (41)(42)(43). Because wall motion abnormalities occur later in the ischemic cascade than perfusion deficits (44), dobutamine stress tests may be less sensitive but more specific for inducible ischemia than perfusion tests.…”