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

The purpose of this work was to test the diagnostic value of dobutamine str ess magnetic resonance imaging (MRI) for predicting recovery of regional my ocardial contractility after revascularization. Cardiac wall motion abnorma lities are due to either non-viable and/or scarred, or viable, but hibernat ing, myocardial tissue. Dobutamine stress leads to increased systolic wall thickening only in viable myocardium. Twenty-five patients with akinetic or dyskinetic myocardial regions were examined with a Cine FLASH-2D sequence at rest and during dobutamine stress (10 mu g/kg/min). Patients were re-exa mined at rest 3, and ist case of persisting wall motion defects, 6 months a fter revascularization. Criterion of viability was increasing end-systolic wall thickening during stress and/or at follow-up. Akinetic regions related either to the LAD (n = 19) or to the RCA (n = 6) were judged viable if >=5 0% of the affected segments improved. MR studies were completed in all subj ects without arrhythmia or need for early terminations due to symptoms. Sen sitivity, specificity, and positive predictive value for the prediction of myocardial viability were 61%, 90%, and 87% for the segment-related analysi s, and 76%, 100%, and 100% for the patient-related analysis based on corona ry artery distribution, respectively. Dobutamiue stress MRI allows to predi ct global functional recovery of akinetic myocardial regions after revascul arization with a high positive predictive value and high specificity. (C) 1 999 Elsevier Science Inc.