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JACC Cardiovasc Imaging. 2011 Feb;4(2):161-72. doi: 10.1016/j.jcmg.2010.11.012.

Long-term prognostic value of dobutamine stress CMR.

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  • 1Department of Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. kelle@dhzb.de

Abstract

OBJECTIVES:

The aim of this study was to assess the long-term value of high-dose dobutamine cardiac magnetic resonance (DCMR) for the prediction of cardiac events in a large cohort of patients with known or suspected coronary artery disease.

BACKGROUND:

High-dose DCMR has been shown to be a useful technique for diagnosis and intermediate-term prognostic stratification.

METHODS:

Clinical data and DCMR results were analyzed in 1,463 consecutive patients undergoing DCMR between 2000 and 2004. Ninety-four patients were lost to follow-up. The remaining 1,369 patients were followed up for a mean of 44 ± 24 months. Cardiac events, defined as cardiac death and nonfatal myocardial infarction, were related to clinical and DCMR results.

RESULTS:

Three-hundred fifty-two patients underwent early revascularization (≤ 3 months of DCMR) and were excluded from analysis. Of the remaining 1,017 patients, 301 patients (29.6%) experienced inducible wall motion abnormalities (WMA). Forty-six cardiac events were reported. In those with and without inducible WMA, the proportion of patients with cardiac events was 8.0% versus 3.1%, respectively, p = 0.001 (hazard ratio: 3.3; 95% confidence interval: 1.8 to 5.9 for the presence of inducible WMA; p < 0.001). A DCMR without inducible WMA carried an excellent prognosis, with a 6-year cardiac event-free survival of 96.8%. In all 1,369 patients in the patient group with stress-inducible WMA, those patients with medical therapy demonstrated a trend to a higher cardiac event rate (8.0%) than those with early revascularization (5.4%) (p = 0.234). Patients with normal DCMR and medical therapy or early revascularization demonstrated similar cumulative cardiac event rates (3.1% vs. 3.2%, p = 0.964).

CONCLUSIONS:

In a large cohort of patients, DCMR has an added value for predicting cardiac events during long-term follow-up, improving the differentiation between high-risk and low-risk patients. Patients with inducible WMA and following early revascularization, demonstrate lower cardiac event rates than patients with medical therapy alone.

Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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PMID:
21329901
[PubMed - indexed for MEDLINE]
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