Author + information
- Received October 17, 2007
- Revision received March 26, 2008
- Accepted April 14, 2008
- Published online July 22, 2008.
- Erica Dall'Armellina, MD⁎,
- Timothy M. Morgan, PhD†,
- Sangeeta Mandapaka, MD⁎,
- William Ntim, MD, FACC⁎,
- J. Jeffrey Carr, MD, FACC†,§,
- Craig A. Hamilton, PhD‡,
- John Hoyle, MD, FACC⁎,
- Hollins Clark, MD§,
- Paige Clark, MD§,
- Kerry M. Link, MD, FACC§,
- Doug Case, PhD† and
- W. Gregory Hundley, MD, FACC⁎,§,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. W. Gregory Hundley, Cardiology Section, Bowman Gray Campus, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1045.
Objectives The purpose of this study was to assess the utility of dobutamine cardiovascular magnetic resonance (DCMR) results for predicting cardiac events in individuals with reduced left ventricular ejection fraction (LVEF).
Background It is unknown whether DCMR results identify a poor cardiac prognosis when the resting LVEF is moderately to severely reduced.
Methods Two hundred consecutive patients ages 30 to 88 (average 64) years with an LVEF ≤55% that were poorly suited for stress echocardiography underwent DCMR in which left ventricular wall motion score index (WMSI), defined as the average wall motion of the number of segments scored, was assessed at rest, during low-dose, and after peak intravenous infusion of dobutamine/atropine. All participants were followed for an average of 5 years after DCMR to ascertain the post-testing occurrence of cardiac death, myocardial infarction (MI), and unstable angina or congestive heart failure warranting hospital stay.
Results After accounting for risk factors associated with coronary arteriosclerosis and MI, a stress-induced increase in WMSI during DCMR was associated with future cardiac events (p < 0.001). A DCMR stress-induced change in WMSI added significantly to predicting future cardiac events (p = 0.003), after accounting for resting LVEF, but this predictive value was confined primarily to those with an LVEF >40%.
Conclusions In individuals with mild to moderate reductions in LVEF (40% to 55%), dobutamine-induced increases in WMSI forecast MI and cardiac death to a greater extent than an assessment of resting LVEF. In those with an LVEF <40%, a dobutamine-induced increase in WMSI does not predict MI and cardiac death beyond the assessment of resting LVEF.
Research was supported in part by the North Carolina Baptist Hospital Technology Development Fund (B-03-97/98 to Dr. Hundley) and the National Institutes of Health (RO1HL076438-01A2 to Dr. Hundley). Drs. Hundley and Hamilton hold a minor financial interest in MRI Cardiac Services, Inc., a company that provides a tool for managing cardiac image display.
- Received October 17, 2007.
- Revision received March 26, 2008.
- Accepted April 14, 2008.
- American College of Cardiology Foundation