Einfluß der Bildqualität auf die Genauigkeit der nichtinvasiven Ischämiediagnostik mit der Dobutamin-Streßmagnetresonanztomographie im Vergleich zur Dobutamin-Streßechokardiographie

Abstract

The analysis of wall motion abnormalities with dobutamine stress echocardiography is an established method for the detection of myocardial ischemia. With ultrafast magnetic resonance tomography, the application of identical stress protocols as used for echocardiography is possible. In 208 consecutive patients (147 M, 61 F) with suspected coronary artery disease, dobutamine stress echocardiography partially using harmonic imaging and dobutamine stress magnetic resonance tomography (DSMR) were performed prior to cardiac catheterization. DSMR images were acquired during short breath holds in 3 short axis-, a 4-, and a 2-chamber view using a turbo gradient echo technique. Patients were examined at rest and during a standard dobutamine-atropine scheme until submaximal heart rate was reached. Regional wall motion was assessed in a 16 segment model. Significant coronary heart disease was defined as angiographic >/=50% diameter stenosis. With DSMR, significantly more patients yielded very good (69%) or good (13%) image quality in comparison with dobutamine stress echocardiography (20% and 31%, p<0. 05). Moderate image quality occurred in 16% with MR and 41% with dobutamine stress echocardiography (p<0.05), 2% and 8% were non-diagnostic. With each technique 18 patients could not be examined (DSE: emphysema: 10, adipositas: 8, DSMR: claustrophobia: 11, adipositas: 6, contraindication: 1). Four patients did not reach target heart rate. In 107 patients, significant coronary artery disease was found. With DSMR sensitivity was 88.7% (dobutamine stress echocardiography: 74.3%; p<0.05) and specificity 85.7% (dobutamine stress echocardiography: 69.8%; p <0.05). This difference was most pronounced in the group with moderate echocardiographic image quality. High dose DSMR is superior to dobutamine stress echocardiography and can replace this technique especially in patients with moderate echocardiographic image quality.

Noninvasive pulmonary transit time: A new parameter for general cardiac performance

“…One important indicator of cardiac function is left ventricular ejection fraction (LVEF), which is derived from the ratio of left ventricular end‐diastolic volumes (LVEDV) and left ventricular end‐systolic volumes (LVESV). However, the ultrasound measures are not always accurate, as calculation is based on geometrical assumptions of a 3D structure or suboptimal image quality …”

Stress-induced worsening of left ventricular diastolic function as a marker of myocardial ischemia

“…This underlines the importance of the study done by Nagel et al . [15] when they showed that the SN of dobutamine stress magnetic resonance was superior to dobutamine SE. The difference was mainly due to moderate echocardiographic images.…”

Multimodality Imaging in Ischemic Cardiomyopathy

“…Limitations of cardiac MR exist, such as claustrophobia (6–15 % [61–63]), which is more frequent due to smaller and longer PET/MR bore [56], impossibility to scan patients with non-MR-compatible implants (pacemaker, defibrillators, metallic clips) or inject contrast in patients with decreased renal function (creatinine clearance rate <30 mL/min/1.73 m 2 ).…”