Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI - Comparison with dobutamine stress echocardiography

Background-The analysis of wall motion abnormalities with dobutamine stress echocardiography (DSE) is an established method for the detection of myoca rdial ischemia, With ultrafast magnetic resonance tomography, identical str ess protocols as used for echocardiography can be applied. Methods and Results-In 208 consecutive patients (147 men, 61 women) with su spected coronary artery disease, DSE with harmonic imaging and dobutamine s tress magnetic resonance (DSMR) (1.5 T) were performed before cardiac cathe terization, DSMR images were acquired during short breath-holds in 3 short- axis views and a 4- and a 2-chamber view (gradient echo technique). Patient s were examined at rest and during a standard dobutamine-atropine scheme un til submaximal heart rate was reached. Regional wall motion was assessed in a 16-segment model. Significant coronary heart disease was defined as grea ter than or equal to 50% diameter stenosis, Eighteen patients could not be examined by DSMR (claustrophobia 11 and adipositas 6) and 18 patients by DS E (poor image quality). Four patients did not reach target heart rate. In 1 07 patients, coronary artery disease was found. With DSMR, sensitivity was increased from 74.3% to 86.2% and specificity from 69.8% to 85.7% (both P<0 .05) compared with DSE. Analysis for women yielded similar results, Conclusions-High-dose dobutamine magnetic resonance tomography can be perfo rmed with a standard dobutamine/ atropine stress protocol. Detection of wal l motion abnormalities by DSMR yields a significantly higher diagnostic acc uracy in comparison to DSE.