Published Online
on April 26, 2004

A more recent version of this article appeared on May 11, 2004

This Article Full Text (PDF) All Versions of this Article: 109/18/2172    most recent 01.CIR.0000128862.34201.74v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wellnhofer, E. Articles by Nagel, E. Search for Related Content PubMed PubMed Citation Articles by Wellnhofer, E. Articles by Nagel, E. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information MRI Scans Related Collections Cardiovascular imaging agents/Techniques CT and MRI Chronic ischemic heart disease

Submitted on October 3, 2003
Revised on March 19, 2004
Accepted on March 23, 2004

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, and Eike Nagel MD

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

^* To whom correspondence should be addressed. E-mail: Ewellnhofer{at}t-online.de.

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

This article has been cited by other articles:

				S. Kelle, S. D. Roes, C. Klein, T. Kokocinski, A. de Roos, E. Fleck, J. J. Bax, and E. Nagel Prognostic value of myocardial infarct size and contractile reserve using magnetic resonance imaging. J. Am. Coll. Cardiol., November 3, 2009; 54(19): 1770 - 1777. [Abstract] [Full Text] [PDF]

				T. D. Karamitsos, J. M. Francis, S. Myerson, J. B. Selvanayagam, and S. Neubauer The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure J. Am. Coll. Cardiol., October 6, 2009; 54(15): 1407 - 1424. [Abstract] [Full Text] [PDF]

				W P Bandettini and A E Arai Advances in clinical applications of cardiovascular magnetic resonance imaging Heart, November 1, 2008; 94(11): 1485 - 1495. [Abstract] [Full Text] [PDF]

				O. Bondarenko, A. M. Beek, J. W.R. Twisk, C. A. Visser, and A. C. van Rossum Time course of functional recovery after revascularization of hibernating myocardium: a contrast-enhanced cardiovascular magnetic resonance study Eur. Heart J., August 2, 2008; 29(16): 2000 - 2005. [Abstract] [Full Text] [PDF]

				S. H. Rahimtoola, V. Dilsizian, C. M. Kramer, T. H. Marwick, and J.-L. J. Vanoverschelde Chronic ischemic left ventricular dysfunction from pathophysiology to imaging and its integration into clinical practice. J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 536 - 555. [Abstract] [Full Text] [PDF]

				D. D. Potter, P. A. Araoz, K. P. McGee, W. S. Harmsen, J. N. Mandrekar, and T. M. Sundt III Low-dose dobutamine cardiac magnetic resonance imaging with myocardial strain analysis predicts myocardial recoverability after coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1342 - 1347. [Abstract] [Full Text] [PDF]

				J. C. Wu, F. M. Bengel, and S. S. Gambhir Cardiovascular Molecular Imaging Radiology, August 1, 2007; 244(2): 337 - 355. [Abstract] [Full Text] [PDF]

				C. M. Bove, J. M. DiMaria, S. Voros, M. R. Conaway, and C. M. Kramer Dobutamine Response and Myocardial Infarct Transmurality: Functional Improvement after Coronary Artery Bypass Grafting--Initial Experience Radiology, September 1, 2006; 240(3): 835 - 841. [Abstract] [Full Text] [PDF]

				F. Sardanelli, M. Quarenghi, T. Schlosser, and J. Barkhausen Delayed Enhancement of Subendocardial Infarcted Myocardium with Gadobenate Dimeglumine: A Paradoxical Effect--Is a Double Dose Too Much? Radiology, September 1, 2006; 240(3): 914 - 916. [Full Text] [PDF]

				T. Baks, R.-J. van Geuns, D. J. Duncker, F. Cademartiri, N. R. Mollet, G. P. Krestin, P. W. Serruys, and P. J. de Feyter Prediction of Left Ventricular Function After Drug-Eluting Stent Implantation for Chronic Total Coronary Occlusions J. Am. Coll. Cardiol., February 21, 2006; 47(4): 721 - 725. [Abstract] [Full Text] [PDF]

				V. Bodi, J. Sanchis, M. P. Lopez-Lereu, A. Losada, J. Nunez, M. Pellicer, V. Bertomeu, F. J. Chorro, and A. Llacer Usefulness of a Comprehensive Cardiovascular Magnetic Resonance Imaging Assessment for Predicting Recovery of Left Ventricular Wall Motion in the Setting of Myocardial Stunning J. Am. Coll. Cardiol., November 1, 2005; 46(9): 1747 - 1752. [Abstract] [Full Text] [PDF]

				I. Paetsch, C. Jahnke, E. Fleck, and E. Nagel Current clinical applications of stress wall motion analysis with cardiac magnetic resonance imaging Eur J Echocardiogr, October 1, 2005; 6(5): 317 - 326. [Abstract] [Full Text] [PDF]

				T A M Kaandorp, H J Lamb, E E van der Wall, A de Roos, and J J Bax Cardiovascular MR to access myocardial viability in chronic ischaemic LV dysfunction Heart, October 1, 2005; 91(10): 1359 - 1365. [Full Text] [PDF]

				P. Chareonthaitawee, B. J. Gersh, P. A. Araoz, and R. J. Gibbons Revascularization in Severe Left Ventricular Dysfunction: The Role of Viability Testing J. Am. Coll. Cardiol., August 16, 2005; 46(4): 567 - 574. [Abstract] [Full Text] [PDF]

				E. E. van der Wall, J. J. Bax, J. B. Selvanayagam, A. Kardos, S. E. Petersen, J. M. Francis, F. Wiesmann, S. Neubauer, and D. P. Taggart Letter Regarding Article by Selvanayagam et al, "Value of Delayed-Enhancement Cardiovascular Magnetic Resonance Imaging in Predicting Myocardial Viability After Surgical Revascularization" * Response Circulation, May 10, 2005; 111(18): e286 - e286. [Full Text] [PDF]

				R. J. Gibbons and P. A. Araoz The year in cardiac imaging J. Am. Coll. Cardiol., November 16, 2004; 44(10): 1937 - 1944. [Full Text] [PDF]

				A. N. Mazzadi, M. F. Janier, B. Brossier, X. Andre-Fouet, D. Revel, and P. Croisille Tagged MRI and PET in severe CAD: discrepancy between preoperative inotropic reserve and intramyocardial functional outcome after revascularization Am J Physiol Heart Circ Physiol, November 1, 2004; 287(5): H2226 - H2233. [Abstract] [Full Text] [PDF]

				H. Samady, C. J. Choi, M. Ragosta, E. R. Powers, G. A. Beller, and C. M. Kramer Electromechanical Mapping Identifies Improvement in Function and Retention of Contractile Reserve After Revascularization in Ischemic Cardiomyopathy Circulation, October 19, 2004; 110(16): 2410 - 2416. [Abstract] [Full Text] [PDF]

				R. J. Kim and W. J. Manning Viability Assessment by Delayed Enhancement Cardiovascular Magnetic Resonance: Will Low-Dose Dobutamine Dull the Shine? Circulation, June 1, 2004; 109(21): 2476 - 2479. [Full Text] [PDF]