Reproducibility and Inter-observer Variability of Dobutamine Stress CMR in Patients with Severe Coronary Disease: Implications for Clinical Research

Syed, Mushabbar A.; Paterson, Ian; Ingkanisorn, W. Patricia; Rhoads, Kenneth L.; Hill, Jonathan; Cannon, Richard O.; Arai, Andrew E.

doi:10.1080/10976640500287414

Cited by 28 publications

(30 citation statements)

References 12 publications

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“…Both positron emission tomography-computed tomography and magnetic resonance imaging offer possible advantages for the assessment of perfusion and function, but these applications remain experimental. In addition, we hope that molecular imaging techniques may offer precise assessment of a meaningful biological end point that would enable confident assessment of our attempts at angiogenesis [27,28,29,30,31]. …”

Section: Discussionmentioning

confidence: 99%

Intracoronary Autologous CD34+ Stem Cell Therapy for Intractable Angina

et al. 2010

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Background/Objectives: A large number of patients with coronary artery disease experience angina that is not suitable for revascularization and is refractory to conventional medical therapy. Laboratory and preclinical studies have provided evidence for the safety and potential efficacy of autologous CD34+ stem cell therapies as treatment for angina. Clinical studies investigating intramyocardial transplantation of autologous CD34+ stem cells by catheter injection for patients with refractory angina show that this is safe and feasible. It remains unclear whether intracoronary infusion of CD34+ stem cells exerts beneficial effects in patients with angina as well. We addressed this question with a controlled clinical trial by enrolling 112 patients with refractory angina. Previous trials have investigated the safety and beneficial effects of CD34+ cells isolated from granulocyte colony-stimulating factor-mobilized peripheral blood; in our trial, we isolated CD34+ cells directly from the patient’s bone marrow. Methods: One hundred and twelve patients with diffuse triple-vessel disease and Canadian Cardiovascular Society class III or IV angina were enrolled in a double-blind, randomized (1:1), placebo-controlled study. Patients received optimal medical treatment but were not candidates for mechanical revascularization (percutaneous coronary intervention or coronary artery bypass grafting). Fifty-six patients (27 women and 29 men aged 42–80 years) were enrolled in the treatment group, and 56 patients (28 women and 28 men aged 43–80 years) who received optimal medical treatment and intracoronary saline injections were enrolled in the placebo control group. Bone marrow was collected from all enrolled patients at a volume of 120–150 ml each in both groups. Selections of CD34+ cells were performed by a CE-marked device approved by the Security, Food and Drug Administration of China. Coronary angiography had been performed before enrollment in this study. Results: No myocardial infarction was observed during intracoronary infusion. The intracoronary infusion of cells or saline did not result in cardiac enzyme elevation, cardiac perforation or pericardial effusion. No arrhythmia, such as ventricular tachycardia or ventricular fibrillation, was induced by intracoronary infusion. No serious adverse events occurred in either group. The reduction in the frequency of angina episodes per week 3 and 6 months after infusion was significantly higher in the treatment group (–14.6 ± 4.8 at 3 months and –15.6 ± 4.0 at 6 months) than in the control group (–4.5 ± 0.3 and –3.0 ± 1.2, respectively; p < 0.01). Other efficacy parameters such as nitroglycerine usage, exercise time and the Canadian Cardiovascular Society class also showed an improvement in the treatment group compared to the control group. A significant improvement in myocardial perfusion was noted in the treatment group compared to the control group, as measured by single-photon emission computed tomography. Conclusions: This randomized trial investigating intracoronary infusi...

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Section: Discussionmentioning

confidence: 99%

Intracoronary Autologous CD34+ Stem Cell Therapy for Intractable Angina

et al. 2010

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“…High-dose dobutamine stress cine MRI revealed good sensitivity and specificity for detection of significant CAD, ranging between 83% and 96% and 80% and 100%, respectively (Table 3) [24, 28,39,[41][42][43][44].…”

Section: Dobutamine Stress Mri In Clinical Trialsmentioning

confidence: 99%

Cardiac stress MR imaging with dobutamine

et al. 2006

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Stress testing for detection of ischemia-induced wall-motion abnormalities has become a mainstay for noninvasive diagnosis and risk stratification of patients with suspected coronary artery disease (CAD). Recent technical developments in magnetic resonance imaging (MRI), including the adoption of balanced steady-state free precession (b-SSFP) sequences-preferentially in combination with parallel imaging techniques-have led to a significant reduction of imaging time and improved patient safety. The stress protocol includes application of high-dose dobutamine (up to 40 microg/kg/min) combined with fractionated atropine (up to a maximal dose of 1.0 mg). High-dose dobutamine stress MRI revealed good sensitivity (83-96%) and specificity (80-100%) for detection of significant CAD. Myocardial tagging methods have been shown to further increase sensitivity for CAD detection. Severe complications (sustained tachycardia, ventricular fibrillation, myocardial infarction, cardiogenic shock) are rare but may be expected in 0.1-0.3% of patients. Dobutamine stress MRI has emerged as a reliable and safe clinical alternative for noninvasive assessment of CAD. New pulse sequences, such as real-time imaging, might obviate the need for breath holding and electrocardiogram (ECG) triggering in patients with severe dyspnoea and cardiac arrhythmias, which may further improve the clinical impact and acceptance of stress MRI in the future.

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“…MRI is a non-invasive, non-ionizing imaging modality with an excellent interstudy reproducibility [6][7][8] and hence is extremely well suited for follow-up study of the same patient. Cardiac MRI is well structured and consists of acquiring a number of planes through the heart in predefined orientations.…”

Section: Cardiac Mrimentioning

confidence: 99%

The role of imaging and molecular imaging in the early detection of metabolic and cardiovascular dysfunctions

et al. 2010

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Despite intense effort, obesity is still rising throughout the world. Links between obesity and cardiovascular diseases are now well established. Most of the cardiovascular changes related to obesity can be followed by magnetic resonance imaging (MRI) or by magnetic resonance spectroscopy (MRS). In particular, we will see in this review that MRI/MRS is extremely well suited to depict (1) changes in cardiac mass and function, (2) changes in stroke volume, (3) accumulation of fat inside the mediastinum or even inside the cardiomyocytes, (4) cell viability and (5) molecular changes during early cardiovascular diseases.

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Reproducibility and Inter-observer Variability of Dobutamine Stress CMR in Patients with Severe Coronary Disease: Implications for Clinical Research

Abstract: Dobutamine CMR is a highly reproducible technique with very good inter-observer variability and could be used as a specific endpoint in a relatively small clinical trial.

Cited by 28 publications

References 12 publications

Intracoronary Autologous CD34+ Stem Cell Therapy for Intractable Angina

Intracoronary Autologous CD34+ Stem Cell Therapy for Intractable Angina

Cardiac stress MR imaging with dobutamine

The role of imaging and molecular imaging in the early detection of metabolic and cardiovascular dysfunctions

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