The role of dobutamine stress cardiovascular magnetic resonance in the clinical management of patients with suspected an
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RESEARCH
Open Access
The role of dobutamine stress cardiovascular magnetic resonance in the clinical management of patients with suspected and known coronary artery disease Rolf Gebker1*, Cosima Jahnke2, Robert Manka1, Thomas Hucko1, Bernhard Schnackenburg3, Sebastian Kelle1, Christoph Klein1, Eckart Fleck1 and Ingo Paetsch2
Abstract Background: Recent studies have demonstrated the consistently high diagnostic and prognostic value of dobutamine stress cardiovascular magnetic resonance (DCMR). The value of DCMR for clinical decision making still needs to be defined. Hence, the purpose of this study was to assess the utility of DCMR regarding clinical management of patients with suspected and known coronary artery disease (CAD) in a routine setting. Methods and Results: We prospectively performed a standard DCMR examination in 1532 consecutive patients with suspected and known CAD. Patients were stratified according to the results of DCMR: DCMR-positive patients were recommended to undergo invasive coronary angiography and DCMR-negative patients received optimal medical treatment. Of 609 (40%) DCMR-positive patients coronary angiography was performed in 478 (78%) within 90 days. In 409 of these patients significant coronary stenoses ≥50% were present (positive predictive value 86%). Of 923 (60%) DCMR-negative patients 833 (90%) received optimal medical therapy. During a mean follow-up period of 2.1 ± 0.8 years (median: 2.1 years, interquartile range 1.5 to 2.7 years) 8 DCMR-negative patients (0.96%) sustained a cardiac event. In 131 DCMR-positive patients who did not undergo invasive angiography, 20 patients (15%) suffered cardiac events. In 90 DCMR-negative patients (10%) invasive angiography was performed within 2 years (range 0.01 to 2.0 years) with 56 patients having coronary stenoses ≥50%. Conclusion: In a routine setting DCMR proved a useful arbiter for clinical decision making and exhibited high utility for stratification and clinical management of patients with suspected and known CAD.
Background Physicians commonly have to determine the need for invasive angiography in patients with suspected or known coronary artery disease (CAD). Current guidelines and recent studies have emphasized the importance of non-invasive stress testing for the detection of myocardial ischemic reactions prior to invasive angiography [1-3]. Dobutamine stress cardiovascular magnetic resonance (DCMR) is well established for the evaluation of patients with suspected and known CAD * Correspondence: [email protected] 1 German Heart Institute Berlin, Germany Full list of author information is available at the end of the article
[4-9]. Apart from merely detecting stress inducible myocardial ischemia, there is growing evidence supporting the value of DCMR to assess cardiac prognosis [10,11]. As for other imaging modalities, patients with an intermediate pretest probability for the presence of CAD benefit most from DCMR [12]. However, data on the usefulness of DCMR testing to direct patient treatment regarding medical versus invasive strat
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