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(Circulation. 2004;109:2172-2174.)
© 2004 American Heart Association, Inc.

Brief Rapid Communications

Magnetic Resonance Low-Dose Dobutamine Test Is Superior to Scar Quantification for the Prediction of Functional Recovery

Ernst Wellnhofer, MD; Adriana Olariu, MD; Christoph Klein, MD; Michael Gräfe, MD; Andreas Wahl, MD; Eckart Fleck, MD; Eike Nagel, MD

From the German Heart Institute, Internal Medicine/Cardiology, Berlin, Germany.

Correspondence to Ernst Wellnhofer, DHZB, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail Ewellnhofer{at}t-online.de

Received October 3, 2003; de novo received December 2, 2003; revision received March 19, 2004; accepted March 23, 2004.

Background— Low-dose dobutamine challenge (DSMR) by MRI was compared with delayed enhancement imaging with Gd-DTPA (SCAR) as a predictor of improvement of wall motion after revascularization (RECOVERY).

Methods and Results— In 29 patients with coronary artery disease (68±7 years of age, 2 women, 32±8% ejection fraction), wall motion was evaluated semiquantitatively by MRI before and 3 months after revascularization. SCAR and DSMR were performed before revascularization. The transmural extent of scar was assessed semiquantitatively. Binary prediction of RECOVERY was performed by logistic regression in 288 segments with wall motion abnormalities at rest. Receiver operating characteristic–area under curve (AUC) statistics were used to compare different models. Low-dose DSMR (AUC 0.838) was superior to SCAR (AUC 0.728) in predicting RECOVERY. SCAR did not improve accuracy of prediction by DSMR. Subgroup analysis showed superiority of DSMR for 1% to 74% transmural extent of infarction.

Conclusions— Low-dose DSMR is superior to SCAR in predicting RECOVERY. This advantage is largest in segments with a delayed enhancement of 1% to 74%.

Key Words: hibernation • revascularization • dobutamine • magnetic resonance imaging

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