Head-to-Head comparison between Contrast-Enhanced magnetic resonance imaging and dobutamine magnetic resonance imaging in men with ischemic cardiomyopathy - 26/08/11
, Jeroen J Bax, MD b, Joanne D Schuijf, MSc a, b, Eric P Viergever, MD b, Ernst E van Der Wall, MD b, Albert de Roos, MD a, Hildo J Lamb, PhD aAbstract |
Contrast-enhanced magnetic resonance imaging (MRI) can predict functional recovery after revascularization. Segments with small, subendocardial scars have a large likelihood of recovery, and segments with transmural infarction have a small likelihood of recovery. Segments with an intermediate extent of infarction have an intermediate likelihood of recovery, and therefore, additional information is needed. Accordingly, the transmurality of infarction on contrast-enhanced MRI was compared with low-dose dobutamine MRI to further define viability in 48 patients. Regional contractile dysfunction was determined by cine MRI at rest (17-segment model), and contractile reserve was determined using low-dose dobutamine infusion. Contrast-enhanced MRI was performed to assess the extent of scar tissue. A total of 338 segments (41%) were dysfunctional, with 61% having contractile reserve. Most segments (approximately 75%) with small, subendocardial scars (hyperenhancement scores 1 or 2) had contractile reserve, whereas contractile reserve was not frequently (17%) observed in segments with transmural infarction (hyperenhancement score 4) (p <0.05). Of segments with an intermediate infarct transmurality (hyperenhancement score 3), contractile reserve was observed in 42%, whereas 58% did not have contractile reserve. In conclusion, the agreement between contrast-enhanced MRI and low-dose dobutamine MRI is large in the extremes (subendocardial scars and transmural scars), and contrast-enhanced MRI may be sufficient to assess the likelihood of the recovery of function after revascularization. However, 61% of segments with an intermediate extent of scar tissue on MRI have contractile reserve and 39% lack contractile reserve. In these segments, low-dose dobutamine MRI may be needed to optimally differentiate myocardium with large and small likelihoods of functional recovery after revascularization.
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 | This work was supported by The Netherlands Organization for Scientific Research, The Hague, The Netherlands. Dr. Kaandorp was supported by grant 902-37-124 from The Netherlands Organisation for Scientific Research, Leiden, The Netherlands. Dr. Lamb was supported by a Schering visiting research fellowship grant funded by Schering AG, Berlin, Germany, as part of the ECR Research and Education Grant 2002, Leiden, The Netherlands. Dr. Schuijf was supported by grant 2002B105 from The Netherlands Heart Foundation, The Hague, The Netherlands, and the Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. |
Vol 93 - N° 12
P. 1461-1464 - juin 2004 Retour au numéro
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