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30 September 2009

Prognostic value of negative dobutamine-stress cardiac magnetic resonance imaging

Sebastian KelleABCDEF, Christina EgnellBCDF, Juliane ViereckeBCDF, Amedeo ChiribiriCDF, Susanne VogelBCDF, Eckart FleckACDEG, Eike NagelACDEFG

Med Sci Monit 2009; 15(10): MT131-136 :: ID: 878198

Abstract

Background
Assessment of left ventricular wall motion during dobutamine-stress magnetic resonance (DSMR) is well established for the identification of myocardial ischemia. However, the integration of DSMR into the process of clinical decision-making in patients with suspected CAD is not well established. The aim of this study was to assess the value of DSMR used for clinical decision-making and to stratify the prognosis following this strategy.
Material and Method
Medical records of 123 consecutive patients suspected of having CAD who underwent high-dose DSMR were reviewed and followed for a median of 23+/-12 months. DSMR results were used for decision-making, for example in favor of catheterization by the referring physician.
Results
Thirty-four (27.6%) patients had inducible ischemia, of whom 31 (91.2%) underwent invasive angiography, 25 (80.6%) having stenoses of >50% in a vessel of > or =2 mm in diameter. Fifteen of these patients received vascularization (PCI/CABG); only two events (myocardial infarction) were observed during follow-up in this group. Eighty-nine (72.4%) patients had no inducible ischemia; 21 of them (23.6%) had invasive angiography resulting in 0 (0%) significant findings. In the remaining 68 (76.4%) patients with negative DSMR and who were not catheterized, an annual event rate of 0% was observed.
Conclusions
DSMR can be used for clinical decision-making in patients suspected of having CAD. This strategy results in a high prevalence of CAD in patients referred for invasive angiography due to a positive DSMR and an excellent prognosis in all patients with a negative DSMR.

Keywords: Myocardial Ischemia - physiopathology, Hemodynamics, Follow-Up Studies, Echocardiography, Stress - methods, Demography, Coronary Artery Disease - ultrasonography

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750