Head to head comparison of dobutamine–transoesophageal echocardiography and dobutamine–magnetic resonance imaging for the prediction of left ventricular functional recovery in patients with chronic coronary artery disease

Abstract

A qualitative visual analysis of TEE and MRI viability studies is highly accurate for the prediction of left ventricular functional recovery in patients with dysfunctional myocardium and proved to be a clinically valuable alternative if transthoracic dobutamine-echocardiography is unsuitable. To date, TEE is cardiologists' preferred choice for the assessment of myocardial viability but MRI may become significantly more attractive with increasing local availability and experience.

Stunning, Hibernation, and Assessment of Myocardial Viability

“…54 In studies that evaluated the improvement of function on a segmental basis (Table 2), SPECT and PET demonstrate excellent sensitivity, whereas echocardiography and cardiovascular magnetic resonance with dobutamine stress have superior specificity and positive predictive value. 22,66,67,70,[72][73][74][75][76][77][78][79][80][81] In a preliminary study in a small group of patients, late-enhancement cardiovascular magnetic resonance in direct comparison with 99m Tc-sestamibi and FDG-PET showed better negative predictive value for segments classified as nonviable 6 months after revascularization. 67 In interpreting these results, we must consider several potential confounding factors.…”

“…In the planning of treatment strategies, a current challenge is the question of how much viable myocardium is required to achieve a significant improvement in LV function after coronary revascularization. General consensus exists that the changes in LVEF after revascularization are linearly correlated with the number of viable segments, 15,64,67,70,73,74,77 although resting LVEF correlates weakly with exercise capacity in heart failure patients. 87,88 Although the relationship between symptoms and severity of underlying disease is elusive, the magnitude of improvement in heart failure symptoms after revascularization in patients with ischemic cardiomyopathy seems to be related to the quantitative extent of myocardial viability.…”

Diagnostic and imaging considerations: Role of viability

“…Thus, segments of less than 5.5 mm in thickness are not very likely to be hibernating, but segments of more than 5.5 mm in thickness may be hibernating or may simply consist of partial-thickness infarction [66]. Contractile reserve can also be evaluated by dobutamine MRI [58] with a sensitivity of 89% and specificity of 94% for detecting hibernation [67].…”

Imaging of the Failing Heart

“…Contractile reserve can also be evaluated by lowdose dobutamine MrI correspondingly to method with echocardiography (22)(23)(24)(25)(26). The strength of MrI is the accuracy of measurement of global and regional function but is moret ime-consuming than echocardiography.I nad irect comparison between dobutamine MrI, thallium and tetrofosmin SPECT in patients with ischemic left ventricular dysfunction undergoing revascularisation, MrIhad alow sensitivity (50%) but ahigh specificity (81%) whereas the nuclear techniques werem ores ensitive but less specific for predicting recovery of regional function (16).…”

“…left ventricular contractile reserve can be evaluated with low-dosed obutaminec ine MrIc orrespondingly to method with echocardiography (22)(23)(24)(25)(26). The strengthofMrI is the accuracy of measurement of global and regional functionb ut is more time-consuming than echocardiography.…”