Abstract 14570: Direct Comparison of CMR Dobutamine Stress Wall Motion Analysis and Perfusion with Adenosine Perfusion in Patients after Bypass Surgery
Introduction: Dobutamine and adenosine stress are the two methods most often used in cardiac magnetic resonance (CMR) for the diagnosis of ischemia and most centers use adenosine perfusion due to its ease to perform. Both methods have demonstrated good Results in patients after coronary artery bypass graft (CABG). However, a direct comparison has not been examined.
Purpose: Comparison of the diagnostic accuracy of wall motion analysis (DSMR) and perfusion (DSPERF) with dobutamine stress with adenosine perfusion (APERF).
Methods: Sixty eight patients (57 men, 65±8 years, BMI 28.7±3.3) after CABG underwent CMR imaging on two appointments. 1) LV-function, DSMR (10–40μg/kg/min + 2mg atropine if needed until target heart rate) imaging (SSFP) of 3 short axis (apical, medial, basal) and 3 long axis views at each stress level. Perfusion imaging of 3 short axis (SSFP, TR/TE 2.8 ms/1.4 ms, FA 50°, SENSE-factor 3.0) were acquired every second heart beat during dobutamine stress at maximal stress level with a contrast bolus of 0.1mmol/kg Gd-DTPA. Late gadolinium enhancement (LGE) imaging (3D inversion recovery technique, TE/TR 2.8/6.6, FA 15°) 10min after additional 0.1mmol/kg Gd-DTPA. 2) Adenosine and rest perfusion (140 μg/min/kg body weight) (SSFP, TE/TR 2.7/1.4, FA 50°, 3 short axis per heart beat) using a 0.05mmol/kg contrast bolus of Gd-DTPA. Invasive coronary angiography served as the reverence. Images were analyzed visually using the standard 16 segment model. Significant stenosis was defined as >50% in a bypass graft or a native vessel ≥ 2mm diameter in areas without 100% transmural LGE.
Results: Prevalence of angiographically significant stenosis was in 63% of patients, after adjustment of the presence of LGE in 42%. Surgery was performed 9.5±6.6 years before CMR. LGE was present in 68% of patients. Sensitivity, specificity and diagnostic accuracy are shown in table 1.
Conclusions: DSMR was the best test for the detection of ischemia in patients after bypass surgery and outperforms adenosine stress perfusion. The addition of DSMR perfusion increases sensitivity, but decreases diagnostic accuracy. Table 1 Sensitivity Specificity Diagnostic accuracy DSMR 88% 96% 93% DSPERF 76% 73% 75% DSMR + DSPERF 94% 73% 83% APERF 75% 91% 85%
- © 2010 by American Heart Association, Inc.