(Circulation. 1999;99:763-770.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Noninvasive Diagnosis of Ischemia-Induced Wall Motion Abnormalities With the Use of High-Dose Dobutamine Stress MRI
Comparison With Dobutamine Stress Echocardiography
From the Department of Internal Medicine/Cardiology, German Heart Institute and Charité Campus Virchow, Humboldt University, Berlin, Germany.
Correspondence to Eike Nagel, MD, Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin und Charité Campus Virchow, Humboldt University, Augustenburger Platz 1, D-13353 Berlin, FRG. E-mail eike.nagel{at}charite.de
Background—The analysis of wall motion abnormalities with dobutamine stress echocardiography (DSE) is an established method for the detection of myocardial ischemia. With ultrafast magnetic resonance tomography, identical stress protocols as used for echocardiography can be applied.
Methods and Results—In 208 consecutive patients (147 men, 61
women) with suspected coronary artery disease, DSE with
harmonic imaging and dobutamine stress magnetic resonance
(DSMR) (1.5 T) were performed before cardiac
catheterization. DSMR images were acquired during short
breath-holds in 3 short-axis views and a 4- and a 2-chamber view
(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 
50%
diameter stenosis. Eighteen patients could not be examined by
DSMR (claustrophobia 11 and adipositas 6) and 18 patients by DSE (poor
image quality). Four patients did not reach target heart rate. In 107
patients, coronary artery disease was found. With DSMR,
sensitivity was increased from 74.3% to 86.2% and specificity from
69.8% to 85.7% (both P<0.05) compared with DSE.
Analysis for women yielded similar results.
Conclusions—High-dose dobutamine magnetic resonance tomography can be performed with a standard dobutamine/atropine stress protocol. Detection of wall motion abnormalities by DSMR yields a significantly higher diagnostic accuracy in comparison to DSE.
Key Words: magnetic resonance imaging • echocardiography • coronary artery disease
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D. Kuijpers, K. Y. J.A.M. Ho, P. R.M. van Dijkman, R. Vliegenthart, and M. Oudkerk Dobutamine Cardiovascular Magnetic Resonance for the Detection of Myocardial Ischemia With the Use of Myocardial Tagging Circulation, April 1, 2003; 107(12): 1592 - 1597. [Abstract] [Full Text] [PDF]
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C. R. Weiss, A. H. Aletras, J. F. London, J. L. Taylor, F. H. Epstein, R. Wassmuth, R. S. Balaban, and A. E. Arai Stunned, Infarcted, and Normal Myocardium in Dogs: Simultaneous Differentiation by Using Gadolinium-enhanced Cine MR Imaging with Magnetization Transfer Contrast Radiology, March 1, 2003; 226(3): 723 - 730. [Abstract] [Full Text] [PDF]
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R. Y. Kwong, A. E. Schussheim, S. Rekhraj, A. H. Aletras, N. Geller, J. Davis, T. F. Christian, R. S. Balaban, and A. E. Arai Detecting Acute Coronary Syndrome in the Emergency Department With Cardiac Magnetic Resonance Imaging Circulation, February 4, 2003; 107(4): 531 - 537. [Abstract] [Full Text] [PDF]
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D. Orlic, J. M. Hill, and A. E. Arai Stem Cells for Myocardial Regeneration Circ. Res., December 13, 2002; 91(12): 1092 - 1102. [Abstract] [Full Text] [PDF]
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W. L. F. Bedaux, M. B. M. Hofman, S. L. A. Vyt, J. G. F. Bronzwaer, C. A. Visser, and A. C. van Rossum Assessment of coronary artery bypass graft disease using cardiovascular magnetic resonance determination of flow reserve J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1848 - 1855. [Abstract] [Full Text] [PDF]
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W. G. Hundley, T. M. Morgan, C. M. Neagle, C. A. Hamilton, P. Rerkpattanapipat, and K. M. Link Magnetic Resonance Imaging Determination of Cardiac Prognosis Circulation, October 29, 2002; 106(18): 2328 - 2333. [Abstract] [Full Text] [PDF]
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S. Schalla, C. Klein, I. Paetsch, H. Lehmkuhl, A. Bornstedt, B. Schnackenburg, E. Fleck, and E. Nagel Real-Time MR Image Acquisition during High-Dose Dobutamine Hydrochloride Stress for Detecting Left Ventricular Wall-Motion Abnormalities in Patients with Coronary Arterial Disease Radiology, September 1, 2002; 224(3): 845 - 851. [Abstract] [Full Text] [PDF]
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G. Theilmeier, P. Verhamme, S. Dymarkowski, H. Beck, H. Bernar, M. Lox, S. Janssens, M.-C. Herregods, E. Verbeken, D. Collen, et al. Hypercholesterolemia in Minipigs Impairs Left Ventricular Response to Stress: Association With Decreased Coronary Flow Reserve and Reduced Capillary Density Circulation, August 27, 2002; 106(9): 1140 - 1146. [Abstract] [Full Text] [PDF]
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H. Mahrholdt, A. Wagner, R.M. Judd, and U. Sechtem Assessment of myocardial viability by cardiovascular magnetic resonance imaging Eur. Heart J., April 2, 2002; 23(8): 602 - 619. [Full Text] [PDF]
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S. B. Reeder, Y. P. Du, J. A. C. Lima, and D. A. Bluemke Advanced Cardiac MR Imaging of Ischemic Heart Disease RadioGraphics, July 1, 2001; 21(4): 1047 - 1074. [Abstract] [Full Text] [PDF]
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D. Pennell IMAGING TECHNIQUES: Cardiovascular magnetic resonance Heart, May 1, 2001; 85(5): 581 - 589. [Full Text]
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G. K. von Schulthess and J. Schwitter Cardiac MR Imaging: Facts and Fiction Radiology, February 1, 2001; 218(2): 326 - 328. [Full Text]
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N. Al-Saadi, E. Nagel, M. Gross, B. Schnackenburg, I. Paetsch, C. Klein, and E. Fleck Improvement of myocardial perfusion reserve early after coronary intervention: assessment with cardiac magnetic resonance imaging J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1557 - 1564. [Abstract] [Full Text] [PDF]
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