Prognostic Value of High-Dose Dobutamine Stress Magnetic Resonance Imaging in 1,493 Consecutive Patients: Assessment of Myocardial Wall Motion and Perfusion

• Published in: Journal of the American College of Cardiology 2010-10, Vol.56 (15), p.1225-1234
• Main Authors: KOROSOGLOU, Grigorios, ELHMIDI, Yacine, ZUGCK, Christian, GIANNITSIS, Evangelos, KATUS, Hugo A, STEEN, Henning, SCHELLBERG, Dieter, RIEDLE, Nina, AHRENS, Johannes, LEHRKE, Stephanie, MERTEN, Constanze, LOSSNITZER, Dirk, RADELEFF, Jannis
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Biological and medical sciences; Body mass index; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Cohort Studies; Coronary Artery Disease - diagnosis; Coronary Artery Disease - physiopathology; Coronary vessels; Data processing; Diabetes; Dobutamine - administration & dosage; Dose-Response Relationship, Drug; Exercise Test - drug effects; Exercise Test - methods; Family medical history; Female; Follow-Up Studies; Heart; Heart attacks; Heart rate; Humans; Hypertension; Ischemia; Kidney diseases; Magnetic Resonance Angiography - methods; Male; Medical sciences; Middle Aged; Myocardial Ischemia - diagnosis; Myocardial Ischemia - physiopathology; Myocardial Perfusion Imaging - methods; NMR; Nuclear magnetic resonance; Prognosis; Prospective Studies; Risk factors
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2010.06.020

This study sought to determine the prognostic value of wall motion and perfusion assessment during high-dose dobutamine stress (DS) cardiac magnetic resonance imaging (MRI) in a large patient cohort. DS-MRI offers the possibility to integrate myocardial perfusion and wall motion analysis in a single examination for the detection of coronary artery disease (CAD). A total of 1,493 consecutive patients with suspected or known CAD underwent DS-MRI, using a standard protocol in a 1.5-T magnetic resonance scanner. Wall motion and perfusion were assessed at baseline and during stress, and outcome data including cardiac death, nonfatal myocardial infarction ("hard events"), and "late" revascularization performed >90 days after the MR scans were collected during a 2 ± 1 year follow-up period. Fifty-three hard events, including 14 cardiac deaths and 39 nonfatal infarctions, occurred during the follow-up period, whereas 85 patients underwent "late" revascularization. Using multivariable regression analysis, an abnormal result for wall motion or perfusion during stress yielded the strongest independent prognostic value for both hard events and late revascularization, clearly surpassing that of clinical and baseline magnetic resonance parameters (for wall motion: adjusted hazard ratio [HR] of 5.9 [95% confidence interval (CI): 2.5 to 13.6] for hard events and of 3.1 [95% CI: 1.7 to 5.6] for late revascularization, and for perfusion: adjusted HR of 5.4 [95% CI: 2.3 to 12.9] for hard events and of 6.2 [95% CI: 3.3 to 11.3] for late revascularization, p < 0.001 for all). DS-MRI can accurately identify patients who are at increased risk for cardiac death and myocardial infarction, separating them from those with normal findings, who have very low risk for future cardiac events. (Prognostic Value of High Dose Dobutamine Stress Magnetic Resonance Imaging; NCT00837005).