This study sought to evaluate dobutamine stress cardiac magnetic resonance imaging (DCMRI) in women with abnormal stress nuclear testing results. Women with findings on stress nuclear exams, including electrocardiography and/or perfusion, thought to require further evaluation with invasive coronary angiography were prospectively enrolled. Multiplane cine imaging was obtained at rest and at each stage of inotropic stress with atropine as needed to achieve target heart rate. DCMRI results were compared with stress nuclear and invasive cardiac catheterization results. Of 23 patients enrolled successfully, 22 completed DCMRI examination without complications. In all cases, DCMRI imaging demonstrated appropriate stress response with no ischemia despite abnormalities on stress nuclear testing. In the 18 patients who also underwent invasive coronary angiography, no significant obstructive disease was identified. DCMRI may be a useful alternative to stress nuclear examination in women; larger studies are warranted to determine its potential to more accurately predict obstructive coronary artery disease. prev cardiol. 2008;11:135-140.
©2008 Le Jacq C ardiovascular disease is the leading cause of mortality in women in the United States. Coronary heart disease, which includes coronary atherosclerotic disease, myocardial infarction, acute coronary syndromes, and angina, is the largest subset of this mortality, with >240,000 women dying annually from the disease.1 However, women often present with atypical signs and symptoms of heart disease. 2,3 As such, noninvasive diagnostic and prognostic testing offers the potential to stratify women at increased coronary artery disease (CAD) risk from those at low risk for obstructive epicardial CAD. However, much of the evidence supporting contemporary recommendations for noninvasive diagnostic studies in women is extrapolated from studies conducted predominantly in cohorts of middle-aged men. Thus, a better understanding of the impact of sex differences in heart disease and on noninvasive cardiac testing in women would greatly improve clinical decision making.Nuclear imaging in women with typical angina in the absence of epicardial coronary stenoses has shown abnormal perfusion scans in some of these patients that may be indistinguishable from those seen due to focal coronary artery lesions. 4 Diastolic dysfunction may be another potential etiology of angina that is also more prevalent in women, 5-9 especially elderly women with hypertension. Exercise stress nuclear imaging is widely used to identify myocardial ischemia in both men and women. An estimated 7.8 million patients underwent nuclear perfusion imaging in 2002, approximately 40% of whom were women.10 While the technique is well established, electrocardiography and attenuation artifact can lead to false-positive diagnoses in women that may prompt subsequent invasive coronary angiography.
11,12Dobutamine stress cardiac magnetic resonance imaging (DCMRI) provides rapid assessment of ischemia without attenuation artifact, 13,14 ...
