Magnetic resonance imaging during dobutamine stress in coronary artery disease

• Published in: The American journal of cardiology Vol. 70; no. 1; pp. 34 - 40
• Main Authors: Pennell, Dudley J., Underwood, S.Richard, Manzara, Carla C., Swanton, R.Howard, Walker, J.Malcolm, Ell, Peter J., Longmore, Donald B.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.1992; Elsevier
• Subjects: Adult; Analysis of Variance; Biological and medical sciences; Cardiology. Vascular system; Coronary Disease - diagnosis; Coronary heart disease; Dipyridamole; Dobutamine; Female; Heart; Humans; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Motion Pictures; Sensitivity and Specificity; Thallium Radioisotopes; Radionuclide study; Human; Pharmacologic test; Thallium; Cardiovascular disease; Exploration; Scintigraphy; Coronary heart disease; Nuclear magnetic resonance imaging; Stress; Myocardium; Diagnosis; Comparative study
• DOI: 10.1016/0002-9149(92)91386-I
• ISSN: 0002-9149

Cine magnetic resonance imaging (MRI) provides a tomographic method of assessing regional ventricular function in any desired plane. It has not been possible to obtain adequate images during dynamic exercise, and this has limited its value in patients with coronary artery disease (CAD). Therefore, an infusion of dobutamine was used to study 25 patients with exertional chest pain and abnormal exercise electrocardiograms. Areas of abnormal wall motion were compared with areas of abnormal myocardial perfusion imaged by dobutamine thallium emission tomography and with coronary arteriography. Twenty-two patients had significant CAD. Twenty-one (96%) of these patients had reversible myocardial ischemia shown by dobutamine thallium tomography, and 20 (91%) had reversible wall motion abnormalities shown by dobutamine MRI. Comparison of abnormal segments of perfusion and wall motion showed 96% agreement at rest, 90% agreement during stress, and 91% agreement for the assessment of functional reversibility. The normalized magnetic resonance signal intensity of the ischemic segments showed a small but significant reduction when compared with that of normal segments (−67 units [9.2%]; p < 0.05). Dobutamine infusion was well-tolerated, despite causing chest discomfort in 24 patients (96%). Nine patients (36%) developed a minor dysrhythmia that was usually ventricular premature complexes, but this did not limit infusion, and other side effects were mild. The short plasma half-life of dobutamine makes it ideal as a stress agent for imaging techniques (such as MRI), and these results suggest that it is more effective in the provocation of wall motion abnormalities than is dipyridamole in patients with CAD.