Skip to main content
PMC home page
Heart logoLink to Heart
. 2000 Jan;83(1):40–46. doi: 10.1136/heart.83.1.40

Dobutamine magnetic resonance imaging as a predictor of myocardial functional recovery after revascularisation

R Trent 1, G Waiter 1, G Hillis 1, F McKiddie 1, T Redpath 1, S Walton 1
PMCID: PMC1729248  PMID: 10618334

Abstract

OBJECTIVE—To assess the use of dobutamine magnetic resonance imaging (MRI) as a preoperative predictor of myocardial functional recovery after revascularisation, comparing wall motion and radial wall thickening analyses by observer and semi-automated edge detection.
PATIENTS—25 men with multivessel coronary disease and resting wall motion abnormalities were studied with preoperative rest and stress MRI.
MAIN OUTCOME MEASURES—Observer analysis for radial wall thickening was compared with a normal range, while wall motion analysis used a standard four point scale. Semi-automated analysis was performed using an edge detection algorithm. Segments displaying either improved or worsened thickening or motion with dobutamine were considered viable. Postoperative rest images were performed 3-6 months after coronary artery bypass grafting (CABG) for comparison.
RESULTS—For observer analysis the values for sensitivity and specificity were 50% and 72% for wall motion, with respective values of 50% and 68% for thickening. With semi-automated edge detection the figures for motion were 60% and 73%, with corresponding values of 79% and 58% for thickening. Combining thickening and motion for the semi-automated method to describe any change in segmental function yielded a sensitivity of 71% and specificity of 70%.
CONCLUSIONS—Dobutamine MRI is a reasonably good predictor of myocardial functional recovery after CABG. The use of semi-automated edge detection analysis improved results.


Keywords: dobutamine; magnetic resonance imaging myocardial viability; coronary artery bypass grafting

Full Text

The Full Text of this article is available as a PDF (100.5 KB).

Figure 1  .

Figure 1  

Open in a new tab

Schematic of short axis segmental views. pos, posterior; inf, inferior; lat, lateral; sep, septal.

Figure 2  .

Figure 2  

Open in a new tab

Linear regression of segmental response to dobutamine versus change in left ventricular ejection fraction within individuals.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Afridi I., Kleiman N. S., Raizner A. E., Zoghbi W. A. Dobutamine echocardiography in myocardial hibernation. Optimal dose and accuracy in predicting recovery of ventricular function after coronary angioplasty. Circulation. 1995 Feb 1;91(3):663–670. doi: 10.1161/01.cir.91.3.663. [DOI] [PubMed] [Google Scholar]
  2. Alderman E. L., Fisher L. D., Litwin P., Kaiser G. C., Myers W. O., Maynard C., Levine F., Schloss M. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation. 1983 Oct;68(4):785–795. doi: 10.1161/01.cir.68.4.785. [DOI] [PubMed] [Google Scholar]
  3. Arnese M., Cornel J. H., Salustri A., Maat A., Elhendy A., Reijs A. E., Ten Cate F. J., Keane D., Balk A. H., Roelandt J. R. Prediction of improvement of regional left ventricular function after surgical revascularization. A comparison of low-dose dobutamine echocardiography with 201Tl single-photon emission computed tomography. Circulation. 1995 Jun 1;91(11):2748–2752. doi: 10.1161/01.cir.91.11.2748. [DOI] [PubMed] [Google Scholar]
  4. Baer F. M., Theissen P., Schneider C. A., Voth E., Sechtem U., Schicha H., Erdmann E. Dobutamine magnetic resonance imaging predicts contractile recovery of chronically dysfunctional myocardium after successful revascularization. J Am Coll Cardiol. 1998 Apr;31(5):1040–1048. doi: 10.1016/s0735-1097(98)00032-1. [DOI] [PubMed] [Google Scholar]
  5. Baer F. M., Voth E., Schneider C. A., Theissen P., Schicha H., Sechtem U. Comparison of low-dose dobutamine-gradient-echo magnetic resonance imaging and positron emission tomography with [18F]fluorodeoxyglucose in patients with chronic coronary artery disease. A functional and morphological approach to the detection of residual myocardial viability. Circulation. 1995 Feb 15;91(4):1006–1015. doi: 10.1161/01.cir.91.4.1006. [DOI] [PubMed] [Google Scholar]
  6. Bax J. J., Wijns W., Cornel J. H., Visser F. C., Boersma E., Fioretti P. M. Accuracy of currently available techniques for prediction of functional recovery after revascularization in patients with left ventricular dysfunction due to chronic coronary artery disease: comparison of pooled data. J Am Coll Cardiol. 1997 Nov 15;30(6):1451–1460. doi: 10.1016/s0735-1097(97)00352-5. [DOI] [PubMed] [Google Scholar]
  7. Bisi G., Sciagrà R., Santoro G. M., Fazzini P. F. Rest technetium-99m sestamibi tomography in combination with short-term administration of nitrates: feasibility and reliability for prediction of postrevascularization outcome of asynergic territories. J Am Coll Cardiol. 1994 Nov 1;24(5):1282–1289. doi: 10.1016/0735-1097(94)90110-4. [DOI] [PubMed] [Google Scholar]
  8. Bluemke D. A., Boxerman J. L., Atalar E., McVeigh E. R. Segmented K-space cine breath-hold cardiovascular MR imaging: Part 1. Principles and technique. AJR Am J Roentgenol. 1997 Aug;169(2):395–400. doi: 10.2214/ajr.169.2.9242742. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Castro P. F., Bourge R. C., Foster R. E. Evaluation of hibernating myocardium in patients with ischemic heart disease. Am J Med. 1998 Jan;104(1):69–77. doi: 10.1016/s0002-9343(97)00312-4. [DOI] [PubMed] [Google Scholar]
  10. Cigarroa C. G., deFilippi C. R., Brickner M. E., Alvarez L. G., Wait M. A., Grayburn P. A. Dobutamine stress echocardiography identifies hibernating myocardium and predicts recovery of left ventricular function after coronary revascularization. Circulation. 1993 Aug;88(2):430–436. doi: 10.1161/01.cir.88.2.430. [DOI] [PubMed] [Google Scholar]
  11. Cornel J. H., Bax J. J., Elhendy A., Maat A. P., Kimman G. J., Geleijnse M. L., Rambaldi R., Boersma E., Fioretti P. M. Biphasic response to dobutamine predicts improvement of global left ventricular function after surgical revascularization in patients with stable coronary artery disease: implications of time course of recovery on diagnostic accuracy. J Am Coll Cardiol. 1998 Apr;31(5):1002–1010. doi: 10.1016/s0735-1097(98)00067-9. [DOI] [PubMed] [Google Scholar]
  12. Cornel J. H., Bax J. J., Elhendy A., Poldermans D., Vanoverschelde J. L., Fioretti P. M. Predictive accuracy of echocardiographic response of mildly dyssynergic myocardial segments to low-dose dobutamine. Am J Cardiol. 1997 Dec 1;80(11):1481–1484. doi: 10.1016/s0002-9149(97)00721-2. [DOI] [PubMed] [Google Scholar]
  13. Di Carli M. F., Davidson M., Little R., Khanna S., Mody F. V., Brunken R. C., Czernin J., Rokhsar S., Stevenson L. W., Laks H. Value of metabolic imaging with positron emission tomography for evaluating prognosis in patients with coronary artery disease and left ventricular dysfunction. Am J Cardiol. 1994 Mar 15;73(8):527–533. doi: 10.1016/0002-9149(94)90327-1. [DOI] [PubMed] [Google Scholar]
  14. Dilsizian V., Rocco T. P., Freedman N. M., Leon M. B., Bonow R. O. Enhanced detection of ischemic but viable myocardium by the reinjection of thallium after stress-redistribution imaging. N Engl J Med. 1990 Jul 19;323(3):141–146. doi: 10.1056/NEJM199007193230301. [DOI] [PubMed] [Google Scholar]
  15. Eitzman D., al-Aouar Z., Kanter H. L., vom Dahl J., Kirsh M., Deeb G. M., Schwaiger M. Clinical outcome of patients with advanced coronary artery disease after viability studies with positron emission tomography. J Am Coll Cardiol. 1992 Sep;20(3):559–565. doi: 10.1016/0735-1097(92)90008-b. [DOI] [PubMed] [Google Scholar]
  16. Feigenbaum H. Exercise echocardiography. J Am Soc Echocardiogr. 1988 Mar-Apr;1(2):161–166. doi: 10.1016/s0894-7317(88)80101-9. [DOI] [PubMed] [Google Scholar]
  17. Gunning M. G., Anagnostopoulos C., Knight C. J., Pepper J., Burman E. D., Davies G., Fox K. M., Pennell D. J., Ell P. J., Underwood S. R. Comparison of 201Tl, 99mTc-tetrofosmin, and dobutamine magnetic resonance imaging for identifying hibernating myocardium. Circulation. 1998 Nov 3;98(18):1869–1874. doi: 10.1161/01.cir.98.18.1869. [DOI] [PubMed] [Google Scholar]
  18. Gunning M. G., Chua T. P., Harrington D., Knight C. J., Burman E., Pennell D. J., Pepper J., Fox K., Underwood S. R. Hibernating myocardium: clinical and functional response to revascularisation. Eur J Cardiothorac Surg. 1997 Jun;11(6):1105–1112. doi: 10.1016/s1010-7940(97)01211-6. [DOI] [PubMed] [Google Scholar]
  19. Haque T., Furukawa T., Takahashi M., Kinoshita M. Identification of hibernating myocardium by dobutamine stress echocardiography: comparison with thallium-201 reinjection imaging. Am Heart J. 1995 Sep;130(3 Pt 1):553–563. doi: 10.1016/0002-8703(95)90366-6. [DOI] [PubMed] [Google Scholar]
  20. Jones E. F., Calafiore P., McNeil J. J., Tonkin A. M., Donnan G. A. Atrial fibrillation with left atrial spontaneous contrast detected by transesophageal echocardiography is a potent risk factor for stroke. Am J Cardiol. 1996 Aug 15;78(4):425–429. doi: 10.1016/s0002-9149(96)00331-1. [DOI] [PubMed] [Google Scholar]
  21. Kaul S. Dobutamine echocardiography for determining myocardial viability after reperfusion: experimental and clinical observations. Eur Heart J. 1995 Nov;16 (Suppl 1000):17–23. doi: 10.1093/eurheartj/16.suppl_m.17. [DOI] [PubMed] [Google Scholar]
  22. Lenfant C. NHLBI funding policies. Enhancing stability, predictability, and cost control. Circulation. 1994 Jul;90(1):1–1. doi: 10.1161/01.cir.90.1.1. [DOI] [PubMed] [Google Scholar]
  23. Lenfant C. NHLBI funding policies. Enhancing stability, predictability, and cost control. Circulation. 1994 Jul;90(1):1–1. doi: 10.1161/01.cir.90.1.1. [DOI] [PubMed] [Google Scholar]
  24. Leung D. A., Debatin J. F., Wildermuth S., McKinnon G. C., von Schulthess G. K. Cardiac imaging: comparison of two-shot echo-planar imaging with fast segmented K-space and conventional gradient-echo cine acquisitions. J Magn Reson Imaging. 1995 Nov-Dec;5(6):684–688. doi: 10.1002/jmri.1880050611. [DOI] [PubMed] [Google Scholar]
  25. Marzullo P., Parodi O., Reisenhofer B., Sambuceti G., Picano E., Distante A., Gimelli A., L'Abbate A. Value of rest thallium-201/technetium-99m sestamibi scans and dobutamine echocardiography for detecting myocardial viability. Am J Cardiol. 1993 Jan 15;71(2):166–172. doi: 10.1016/0002-9149(93)90733-s. [DOI] [PubMed] [Google Scholar]
  26. Marzullo P., Sambuceti G., Parodi O., Gimelli A., Picano E., Giorgetti A., L'Abbate A. Regional concordance and discordance between rest thallium 201 and sestamibi imaging for assessing tissue viability: comparison with postrevascularization functional recovery. J Nucl Cardiol. 1995 Jul-Aug;2(4):309–316. doi: 10.1016/s1071-3581(05)80075-3. [DOI] [PubMed] [Google Scholar]
  27. Matter C., Nagel E., Stuber M., Boesiger P., Hess O. M. Assessment of systolic and diastolic LV function by MR myocardial tagging. Basic Res Cardiol. 1996;91 (Suppl 2):23–28. doi: 10.1007/BF00795358. [DOI] [PubMed] [Google Scholar]
  28. Maublant J. C., Citron B., Lipiecki J., Mestas D., Bailly P., Veyre A., de Riberolles C., Ponsonnaille J. Rest technetium 99m-sestamibi tomoscintigraphy in hibernating myocardium. Am Heart J. 1995 Feb;129(2):306–314. doi: 10.1016/0002-8703(95)90013-6. [DOI] [PubMed] [Google Scholar]
  29. Maurea S., Cuocolo A., Soricelli A., Castelli L., Nappi A., Squame F., Imbriaco M., Trimarco B., Salvatore M. Enhanced detection of viable myocardium by technetium-99m-MIBI imaging after nitrate administration in chronic coronary artery disease. J Nucl Med. 1995 Nov;36(11):1945–1952. [PubMed] [Google Scholar]
  30. Perrone-Filardi P., Pace L., Prastaro M., Piscione F., Betocchi S., Squame F., Vezzuto P., Soricelli A., Indolfi C., Salvatore M. Dobutamine echocardiography predicts improvement of hypoperfused dysfunctional myocardium after revascularization in patients with coronary artery disease. Circulation. 1995 May 15;91(10):2556–2565. doi: 10.1161/01.cir.91.10.2556. [DOI] [PubMed] [Google Scholar]
  31. Persili S. A., Kiss A., Langewitz W. A., Steinbrich W. Anxiety during MRI. JAMA. 1994 Apr 6;271(13):981–982. [PubMed] [Google Scholar]
  32. Pigott J. D., Kouchoukos N. T., Oberman A., Cutter G. R. Late results of surgical and medical therapy for patients with coronary artery disease and depressed left ventricular function. J Am Coll Cardiol. 1985 May;5(5):1036–1045. doi: 10.1016/s0735-1097(85)80003-6. [DOI] [PubMed] [Google Scholar]
  33. Piérard L. A., De Landsheere C. M., Berthe C., Rigo P., Kulbertus H. E. Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolytic therapy: comparison with positron emission tomography. J Am Coll Cardiol. 1990 Apr;15(5):1021–1031. doi: 10.1016/0735-1097(90)90236-i. [DOI] [PubMed] [Google Scholar]
  34. Rahimtoola S. H. The hibernating myocardium. Am Heart J. 1989 Jan;117(1):211–221. doi: 10.1016/0002-8703(89)90685-6. [DOI] [PubMed] [Google Scholar]
  35. Sambuceti G., Parodi O., Marzullo P., Giorgetti A., Fusani L., Puccini G., Salvadori P., L'Abbate A. Regional myocardial blood flow in stable angina pectoris associated with isolated significant narrowing of either the left anterior descending or left circumflex coronary artery. Am J Cardiol. 1993 Nov 1;72(14):990–994. doi: 10.1016/0002-9149(93)90850-c. [DOI] [PubMed] [Google Scholar]
  36. Sawada S., Elsner G., Segar D. S., O'Shaughnessy M., Khouri S., Foltz J., Bourdillon P. D., Bates J. R., Fineberg N., Ryan T. Evaluation of patterns of perfusion and metabolism in dobutamine-responsive myocardium. J Am Coll Cardiol. 1997 Jan;29(1):55–61. doi: 10.1016/s0735-1097(96)00430-5. [DOI] [PubMed] [Google Scholar]
  37. Sayad D. E., Willett D. L., Hundley W. G., Grayburn P. A., Peshock R. M. Dobutamine magnetic resonance imaging with myocardial tagging quantitatively predicts improvement in regional function after revascularization. Am J Cardiol. 1998 Nov 1;82(9):1149-51, A10. doi: 10.1016/s0002-9149(98)00579-7. [DOI] [PubMed] [Google Scholar]
  38. Sechtem U., Sommerhoff B. A., Markiewicz W., White R. D., Cheitlin M. D., Higgins C. B. Regional left ventricular wall thickening by magnetic resonance imaging: evaluation in normal persons and patients with global and regional dysfunction. Am J Cardiol. 1987 Jan 1;59(1):145–151. doi: 10.1016/s0002-9149(87)80088-7. [DOI] [PubMed] [Google Scholar]
  39. Semelka R. C., Tomei E., Wagner S., Mayo J., Kondo C., Suzuki J., Caputo G. R., Higgins C. B. Normal left ventricular dimensions and function: interstudy reproducibility of measurements with cine MR imaging. Radiology. 1990 Mar;174(3 Pt 1):763–768. doi: 10.1148/radiology.174.3.2305059. [DOI] [PubMed] [Google Scholar]
  40. Sklenar J., Ismail S., Villanueva F. S., Goodman N. C., Glasheen W. P., Kaul S. Dobutamine echocardiography for determining the extent of myocardial salvage after reperfusion. An experimental evaluation. Circulation. 1994 Sep;90(3):1502–1512. doi: 10.1161/01.cir.90.3.1502. [DOI] [PubMed] [Google Scholar]
  41. Stavri G. T., Zachary I. C., Baskerville P. A., Martin J. F., Erusalimsky J. D. Basic fibroblast growth factor upregulates the expression of vascular endothelial growth factor in vascular smooth muscle cells. Synergistic interaction with hypoxia. Circulation. 1995 Jul 1;92(1):11–14. doi: 10.1161/01.cir.92.1.11. [DOI] [PubMed] [Google Scholar]
  42. Udelson J. E., Coleman P. S., Metherall J., Pandian N. G., Gomez A. R., Griffith J. L., Shea N. L., Oates E., Konstam M. A. Predicting recovery of severe regional ventricular dysfunction. Comparison of resting scintigraphy with 201Tl and 99mTc-sestamibi. Circulation. 1994 Jun;89(6):2552–2561. doi: 10.1161/01.cir.89.6.2552. [DOI] [PubMed] [Google Scholar]
  43. Vanoverschelde J. L., D'Hondt A. M., Marwick T., Gerber B. L., De Kock M., Dion R., Wijns W., Melin J. A. Head-to-head comparison of exercise-redistribution-reinjection thallium single-photon emission computed tomography and low dose dobutamine echocardiography for prediction of reversibility of chronic left ventricular ischemic dysfunction. J Am Coll Cardiol. 1996 Aug;28(2):432–442. doi: 10.1016/0735-1097(96)00167-2. [DOI] [PubMed] [Google Scholar]
  44. Waiter G. D., McKiddie F. I., Redpath T. W., Semple S. I., Trent R. J. Determination of normal regional left ventricular function from cine-MR images using a semi-automated edge detection method. Magn Reson Imaging. 1999 Jan;17(1):99–107. doi: 10.1016/s0730-725x(98)00158-1. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES