Long-term prognostic value of dobutamine stress CMR

Sebastian Kelle, Amedeo Chiribiri, Juliane Vierecke, Christina Egnell, Ashraf Hamdan, Cosima Jahnke, Ingo Paetsch, Ernst Wellnhofer, Eckart Fleck, Christoph Klein, Rolf Gebker

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)161-172
Number of pages12
JournalJACC: Cardiovascular Imaging
Volume4
Issue number2
DOIs
StatePublished - Feb 2011

Keywords

  • coronary artery disease
  • dobutamine cardiac magnetic resonance
  • prognosis

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