Clin Res Cardiol 101, Suppl 1, April 2012

V141 - Dobutamine Stress Cardiac Magnetic Resonance versus Echocardiography for the Assessment of Outcome. Are the 2 Imaging Modalities Comparable?
 
E. Bikiri1, D. Mereles1, S. Buß1, N. Hofmann1, G. Gitsioudis1, E. Giannitsis1, H. A. Katus1, G. Korosoglou1
 
1Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg;
 
Purpose: To compare the value of Dobutamine Stress Echocardiography (DSE) with that provided by Dobutamine Stress Magnetic Resonance Imaging (DS-MRI) for the non-invasive risk stratification of patients with suspected or known coronary artery disease (CAD).
 Background: Both DSE and DS-MRI are implemented in the daily diagnostic work-up of patients with ischemic heart disease. Although DS-MRI was previously shown to aid the diagnostic classification of patients with suspected CAD with higher sensitivity and accuracy compared to that provided by DSE, the value of the 2 techniques for the risk stratification of patients with CAD has not been investigated so far.
Methods: Patients with suspected or known CAD underwent either DSE or DS-MRI for clinical reasons using the same standardised high-dose dobutamine/atropine protocol. Patient matching was performed for age, gender and coronary risk factors. Wall motion was assessed at rest and during maximum stress, and outcome data including cardiac death and non-fatal myocardial infarction (defined as hard cardiac events) and ‘late’ revascularization performed >90 days after the MR-scans were prospectively collected at least 6 months after DSE or DS-MRI.
Results: Follow-up data were available in 1392 patients who underwent either DSE (n=696) or DS-MRI (n=696) during a mean follow-up duration of 3.8±2.0 and 3.4±1.7yrs, respectively. Patients exhibited an overall medium to high risk profile (70±9yrs; 73% male and 27% diabetes mellitus in the DSE and 69±9yrs, 71% male and 27% with diabetes mellitus in the DS-MRI group). Both modalities succesfully identified patients with inducible ischemia, who excibited significantly higher rates of subsequent hard cardiac events compared to those with negative stress test results (Hazard ratio (HR)=7.7; 95%CI=3.5-17.0 for DS-MRI versus 3.1; 95%CI=1.9-5.0 for DSE), (Figure 1). However, patients with negative DS-MRI excibited significant lower event rates compared to those with negative DSE (annual hard cardiac event rate of 0.9% versus 3.2% within the first 3yrs of follow-up; p=0.005).
Conclusions: Both DSE and DS-MRI aid the risk stratification of patients with ischemic heart disease. However, inducible WMA during DS-MRI are associated with a higher hazard ratio for subsequent hard cardiac events compared to DSE. Furthermore, patients with negative DS-MRI exhibit a lower annual event rate during follow-up, compared to those with a negative DSE test result. This is possibly associated with better endocardial border detection of the myocardium during DS-MRI resulting in higher sensitivity for ischemia detection and in a lower rate of false negative results.

 


 

Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6

http://www.abstractserver.de/dgk2012/ft/abstracts/V141.htm