Abstract 9458: Influence of Left Ventricular and Geometry on Diagnostic Accuracy of Wall Motion and Perfusion Analysis during Dobutamine Stress Magnetic Resonance
Background: The aim of this study was to determine the influence of left ventricular hypertrophy and geometry on the diagnostic accuracy of wall motion and perfusion imaging during high dose dobutamine stress magnetic resonance.
Methods and Results: Combined wall motion (DSMR—wall motion) and perfusion imaging (DSMR—perfusion) was performed in a single session in 187 patients scheduled for invasive coronary angiography. Patients were classified into four categories based on LV mass (normal ≤81 g/m2 in men, ≤62 g/m2 in women) and relative wall thickness (RWT, normal <0.45): normal geometry, concentric remodeling, concentric hypertrophy and eccentric hypertrophy. Wall motion and perfusion images were interpreted sequentially, blinded to other data. Significant coronary artery disease (CAD) was defined as ≥70% stenosis. For the overall population, the use of DSMR—perfusion vs. DSMR—wall motion to detect CAD showed a non—significant trend for improved sensitivity (90% vs. 80%, p=0.06), while specificity was significantly lower (77% vs. 83%, P=0.02). In patients with increased LV concentricity sensitivity and accuracy of DSMR—wall motion were significantly reduced (63% and 73%, respectively) compared to patients without increased LV concentricity (90% and 88%, p<0.05, respectively). While accuracy of DSMR—perfusion was higher compared to DSMR—wall motion in patients with concentric hypertrophy (82% vs. 71%, p<0.05, see Figure for imaging example), accuracy of DSMR—wall motion was superior (90% vs. 85%, p<0.05) in patients with eccentric hypertrophy.
Conclusion: The accuracy of DSMR—wall motion is influenced by LV mass and geometry. In patients with concentric remodeling and concentric hypertrophy additional first—pass perfusion imaging during high dose dobutamine stress improves the diagnostic accuracy for the detection of CAD.
- © 2010 by American Heart Association, Inc.