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
Fm. Baer et al., 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, EUR HEART J, 21(12), 2000, pp. 981-991
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.