Magnetic Resonance Low-Dose Dobutamine Test Is Superior to Scar Quantification for the Prediction of Functional Recovery

Wellnhofer, Ernst; Olariu, Adriana; Klein, Christoph; Gräfe, Michael; Wahl, Andreas; Fleck, Eckart; Nagel, Eike

doi:10.1161/01.cir.0000128862.34201.74

Cited by 288 publications

(160 citation statements)

References 30 publications

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“…Roes et al 54 commented that only 53% of segments with subendocardial scar with 1%-50% transmurality in the study of Kim et al 40 showed functional recovery. The addition of dobutamine stress CMR has been advocated in patients with 25%-75% transmurality to improve diagnostic performance 56 and is mentioned further below.…”

Section: Cmr Imagingmentioning

confidence: 99%

Noninvasive assessment myocardial viability: Current status and future directions

Allman

2013

Journal of Nuclear Cardiology

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Observations of reversibility of cardiac contractile dysfunction in patients with coronary artery disease and ischemia were first made more than 40 years ago. Since that time a wealth of basic science and clinical data has been gathered exploring the mechanisms of this phenomenon of myocardial viability and relevance to clinical care of patients. Advances in cardiac imaging techniques have contributed greatly to knowledge in the area, first with thallium-201 imaging, then later with Tc-99m-based tracers for SPECT imaging and metabolic tracers used in conjunction with positron emission tomography (PET), most commonly F-18 FDG in conjunction with blood flow imaging with N-13 ammonia or Rb-82 Cl. In parallel, stress echocardiography has made great progress also. Over time observational studies in patients using these techniques accumulated and were later summarized in several meta-analyses. More recently, cardiac magnetic resonance imaging (CMR) has contributed further information in combination with either late gadolinium enhancement imaging or dobutamine stress. This review discusses the tracer and CMR imaging techniques, the pooled observational data, the results of clinical trials, and ongoing investigation in the field. It also examines some of the current challenges and issues for researchers and explores the emerging potential of combined PET/CMR imaging for myocardial viability.

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Section: Cmr Imagingmentioning

confidence: 99%

Noninvasive assessment myocardial viability: Current status and future directions

Allman

2013

Journal of Nuclear Cardiology

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“…An improvement of regional contractility during a continuous infusion of dobutamine at a dose of 10 µg/kg body weight/min or less has been shown to be a powerful predictor of functional recovery after revascularization therapy (54), and is a better predictor of LV functional recovery after revascularization than end-diastolic wall thickness (55). However, this method is limited by assessing viability indirectly through an assessment of function as a surrogate, which can be hampered in the presence of dysfunctional (eg, stunned or hibernating) tissue (56).…”

Section: Assessment Of Myocardial Viability In Ischemic Heart Diseasementioning

confidence: 99%

The emerging clinical role of cardiovascular magnetic resonance imaging

Kumar¹,

Patton²,

Friedrich³

2010

Canadian Journal of Cardiology

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“…However, several studies showed that this may not be the case. Motoyasu et al [28] found low-dose dobutamine CMR to have a superior receiver operating characteristic (ROC) over the LGE technique (ROC area under the curve of 0.87 vs 0.78), whereas Wellnhofer et al [29] further showed that low-dose dobutamine CMR is particularly useful in predicting functional recovery in myocardial segments with transmural involvement by LGE of less than 75%. Similarly, Kaandorp et al [30] showed that low-dose dobutamine may improve viability assessment in patients with an intermediate degree of transmural involvement by LGE.…”

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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Magnetic Resonance Low-Dose Dobutamine Test Is Superior to Scar Quantification for the Prediction of Functional Recovery

Cited by 288 publications

References 30 publications

Noninvasive assessment myocardial viability: Current status and future directions

Noninvasive assessment myocardial viability: Current status and future directions

The emerging clinical role of cardiovascular magnetic resonance imaging

Cardiac magnetic resonance imaging in patients with coronary disease

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