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

Aims A substantial number of patients with dysfunctional but potentially vi able myocardium cannot be accurately evaluated by transthoracic echocardiog raphy due to a poor acoustic window. This study compares the diagnostic val ue of alternative functional imaging techniques, such as dobutamine-transoe sophageal echocardiography (dobutamine-TEE) and dobutamine magnetic resonan ce imaging (dobutamine-MRI) for the detection of viable myocardium and the prediction of left ventricular functional recovery in patients with chronic coronary artery disease following successful revascularization procedures. Methods and Results Rest and low-dose (5, 10 mu g dobutamine. min(-1). kg(- 1)) multiplane dobutamine-TEE and ultrafast cine-MRI studies were performed in 103 patients. Contractile recovery of an infarct region was predicted i f a dobutamine contraction reserve could be assessed visually by TEE or MRI in greater than or equal to 50% of infarct-related a- or dyskinetic segmen ts. Revascularization of the infarct-related vessel was successful in 88 pa tients, and 4.9 +/- 0.7 months later 52 patients still had an angiographica lly controlled open target vessel. These patients underwent another rest MR I study to assess left ventricular functional recovery. A dobutamine contra ction reserve was observed in 27/52 (52%) patients by TEE and in 26/52 (50% ) patients by MRI. Functional improvement of the infarct region was diagnos ed in 28/52 (54%) patients. The positive and negative predictive accuracy o f dobutamine-TEE and dobutamine-MRI for the prediction of left ventricular functional recovery was not significantly different (85% vs 92%, ns and 80% vs 85%, ns). Diagnosis of a predominantly viable infarct region by TEE and MRI predicted a significant increase in left ventricular ejection fraction (TEE: 12 +/- 18% vs 2 +/- 7% P<0.001, MRI: 13 +/- 17% vs 2 +/- 7%, P<0.001 ) compared to infarct regions graded as scar. Conclusion A qualitative visual analysis of TEE and MRI viability studies i s highly accurate for the prediction of left ventricular functional recover y in patients with dysfunctional myocardium and proved to be a clinically v aluable alternative if transthoracic dobutamine-echocardiography is unsuita ble. 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. (Eur Heart J 2000; 21: 981-99 1) (C) 2000 The European Society of Cardiology.