Abstract 2830: Additional Value of Myocardial Perfusion Imaging during Dobutamine Stress Magnetic Resonance for the Assessment of Coronary Artery Disease
Background: Dobutamine stress magnetic resonance (DSMR) imaging has emerged as a valuable tool for the detection of inducible wall motion abnormalities (WMA). The role of perfusion imaging during DSMR is not well defined. We examined whether the addition of myocardial perfusion imaging during DSMR provides incremental benefit for the evaluation of coronary artery disease (CAD).
Methods and Results: DSMR was combined with perfusion imaging (DSMRP) in 455 consecutive patients who were scheduled for clinically indicated invasive coronary angiography. Perfusion images were acquired in three standard short axis views at rest and during maximum dobutamine-atropine stress. Wall motion and perfusion images were interpreted sequentially, blinded to other data. Significant (≥70%) stenoses were present in 285 patients in invasive coronary angiography. For the overall population the addition of perfusion imaging improved sensitivity for the detection of CAD (91% versus 85%, P=0.001) with a significant reduction in specificity (70% vs. 82%, P=0.001) and no difference in diagnostic accuracy (84% vs. 84%, P n.s.). DSMRP enabled the correct diagnosis of CAD in an additional 13% of patients. DSMRP enhanced diagnostic accuracy in patients with left ventricular hypertrophy (LVH) (87% vs. 80%, P<0.001), resting WMAs (84% vs. 80%, P<0.001), prior CAD (85% vs. 82%, P<0.001) and it improved sensitivity in patients with single vessel disease (91% vs. 84%, P<0.001).
Conclusion: The addition of perfusion imaging during DSMR is a useful technique for the diagnosis of CAD and adds additional diagnostic value in patients with LVH, resting WMAs, prior CAD and single-vessel disease.