Detection of myocardial viability by low-dose dobutamine cine MR imaging

Sandstede, J.; Bertsch, Gerald; Beer, Meinrad; Kenn, W.; Werner, Edgar; Pabst, Thomas; Lipke, Claudia; Kretschmer, Susanne; Neubauer, Stefan; Hahn, Dietbert

doi:10.1016/s0730-725x(99)00095-8

Cited by 79 publications

(34 citation statements)

References 24 publications

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“…Low-dose dobutamine CMR was specific (81%) but insensitive (50%) for functional improvement. Likewise, Sandstede et al 19 found a low sensitivity (61%) but high specificity (90%) for improved segmental wall motion. The latter two studies are consistent with the dobutamine echocardiography literature, which also demonstrate relatively modest sensitivity but high specificity for prediction of functional improvement.…”

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confidence: 93%

Viability Assessment by Delayed Enhancement Cardiovascular Magnetic Resonance

Kim

Manning

2004

Circulation

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Since mechanical revascularization methods such as coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention became available, the issue of identifying dysfunctional yet viable myocardium has been of crucial clinical importance. Among patients with ischemic cardiomyopathy and viable myocardium, mechanical revascularization is associated with improved systolic function, symptoms, and survival, 1-3 yet the best method to identify viable myocardium remains disputed. Current options include positron-emission tomography (PET) to assess myocardial metabolic activity, single-photon emission computed tomography (SPECT) with technetium-99m sestamibi or thallium-201 to assess myocardial perfusion and membrane integrity, and dobutamine echocardiography or cine cardiovascular magnetic resonance (CMR) to assess myocardial contractile reserve. Each approach, however, has limitations. For example, the index measured may not reflect the quantity of viable myocytes but rather a physiological parameter, such as perfusion or contractile reserve, that has only an indirect relation to viability. Other limitations include partial volume effects due to poor spatial resolution (SPECT, PET), attenuation and scatter artifacts (SPECT), and the occasional inability to visualize all parts of the left ventricle (dobutamine echocardiography). See Circulation. 2004;109:2172-2174.More recently, studies have demonstrated the effectiveness of a new CMR technique, delayed contrast-enhanced CMR (DE-CMR) for detecting myocardial infarction and determining viability with much higher spatial resolution than SPECT. 4,5 Data from animal models of ischemic injury demonstrate that DE-CMR can distinguish between reversible and irreversible myocardial injury independent of wall motion, infarct age, or reperfusion status. 4,6,7 Human studies demonstrate that DE-CMR is effective in identifying the presence, location, and extent of myocardial infarction in both the acute and chronic settings, 8,9 with scar size measurements that are closely correlated with PET in patients with ischemic cardiomyopathy 10 and results superior to SPECT in patients with small infarctions. 5 Notably, DE-CMR can be used to predict reversible myocardial dysfunction in patients undergoing revascularization procedures. [11][12][13] Currently, there are few data directly comparing DE-CMR to other "viability" imaging tests for the prediction of left ventricular (LV) wall motion response to revascularization. In the May 11, 2004, issue of Circulation, Wellnhofer and colleagues 14 reported on DE-CMR and low-dose dobutamine cine CMR performed 1 day before revascularization in 29 patients with chronic coronary artery disease and resting LV dysfunction. Resting cine CMR was performed 3 months after revascularization to assess changes in wall motion. The transmural extent of scar (hyperenhancement) was assessed visually from the DE-CMR images using a 5-grade scale, and likewise, wall motion was assessed visually using a semiquantitative scale, both at rest and under 5 ...

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confidence: 93%

Viability Assessment by Delayed Enhancement Cardiovascular Magnetic Resonance

Kim

Manning

2004

Circulation

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“…Delayed-enhancement cardiac viability magnetic resonance imaging was established in the 1980s when initial reports confirmed the delayed gadolinium contrast enhancement on T1-weighted magnetic resonance images in 1984 (Wesbey et al 1984;Ordovas and Higgins 2011). Cardiac MR (CMR) imaging, either by delayed contrast enhancement or by low-dose dobutamine challenge, is the noninvasive ''gold-standard'' for evaluating myocardial viability and infarct morphology (Judd et al 1995;Kim et al 1999;Fieno et al 2000;Dendale et al 1998;Sandstede et al 1999;Wellnhofer et al 2004).…”

Section: Myocardial Infarction: Imaging Perspectivementioning

confidence: 99%

CT Assessment of Myocardial Viability: Quantitive Imaging

Ruzsics

2012

CT Imaging of Myocardial Perfusion and Viability

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“…• Improvement in regional wall motion abnormalities in response to low-dose (5-10 µg/kg/min) dobutamine challenge has been well validated for viability assessment from the vast body of evidence from echocardiography as well as from CMR [22][23][24]. When compared with PET, this technique showed a high sensitivity of 88% and specificity of 87% for detecting viable myocardial segments in patients with mild left ventricular dysfunction [25].…”

Section: Functional Reserve With Low-dose Dobutaminementioning

confidence: 99%

“…When compared with PET, this technique showed a high sensitivity of 88% and specificity of 87% for detecting viable myocardial segments in patients with mild left ventricular dysfunction [25]. However, this technique has been shown to have limited specificity, in the range of 50% to 70%, with segments exhibiting resting akinesia or dyskinesia [24,26]. This is attributed to the fact that in the presence of severe coronary stenosis and hypoperfusion, viable myocardial segments may fail to demonstrate contractile reserve with low-dose dobutamine because of rapid development of ischemia [27].…”

Section: Functional Reserve With Low-dose Dobutaminementioning

confidence: 99%

Cardiac magnetic resonance imaging in patients with coronary disease

Kwong

2008

Curr Treat Options Cardio Med

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Cardiac magnetic resonance (CMR) has emerged as a versatile noninvasive tool for the comprehensive evaluation of patients with suspected or established coronary artery disease (CAD). In a single imaging session, CMR can assess left ventricular anatomy and function, myocardial perfusion, viability, and coronary luminal stenosis. Using specific pulse sequences, left ventricular global and regional function can be assessed by cine CMR at rest and in response to inotropic stress; first-pass perfusion quantified by vasodilator stress; myocardial viability evaluated by delayed enhancement imaging and also by functional reserve; and coronary artery stenosis assessed by angiography. All these modalities can be achieved with high spatial resolution and image contrast, without exposure to ionizing radiation, and within a reasonable time frame of about 1 hour of scan time. Also, the imaging planes can be programmed to provide identical views of the heart for each type of image, thereby facilitating intermodality comparisons. There is early but accumulating evidence that the accuracy and prognostic values of many of these modalities are comparable or superior to radionuclide scintigraphy and echocardiography in headto-head studies. Current limitations unique to CMR include the inability to perform exercise stress testing inside the CMR suite and exclusion of patients with indwelling metallic devices such as defibrillators and pacemakers. Despite these limitations, CMR is unique in its multifaceted approach that can be specifically tailored to the clinical question at hand, making it arguably the best tool for the diagnosis and management of CAD. With the rapid pace of advancement in CMR hardware and pulse sequence technologies, the clinical use of this powerful technique is likely to grow even greater in this area.

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Detection of myocardial viability by low-dose dobutamine cine MR imaging

Cited by 79 publications

References 24 publications

Viability Assessment by Delayed Enhancement Cardiovascular Magnetic Resonance

Viability Assessment by Delayed Enhancement Cardiovascular Magnetic Resonance

CT Assessment of Myocardial Viability: Quantitive Imaging

Cardiac magnetic resonance imaging in patients with coronary disease

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