Comprehensive dobutamine stress CMR versus echocardiography in LBBB and suspected coronary artery disease

Mordi, Ify, Stanton, Tony, Carrick, David, McClure, John, Oldroyd, Keith, Berry, Colin and Tzemos, Nikolaos (2014) Comprehensive dobutamine stress CMR versus echocardiography in LBBB and suspected coronary artery disease. JACC: Cardiovascular Imaging, 7 5: 490-498. doi:10.1016/j.jcmg.2014.01.012

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Author Mordi, Ify
Stanton, Tony
Carrick, David
McClure, John
Oldroyd, Keith
Berry, Colin
Tzemos, Nikolaos
Title Comprehensive dobutamine stress CMR versus echocardiography in LBBB and suspected coronary artery disease
Journal name JACC: Cardiovascular Imaging   Check publisher's open access policy
ISSN 1936-878X
Publication date 2014-04-09
Sub-type Article (original research)
DOI 10.1016/j.jcmg.2014.01.012
Volume 7
Issue 5
Start page 490
End page 498
Total pages 9
Place of publication New York, NY, United States
Publisher Elsevier
Language eng
Formatted abstract
Objectives We aimed to compare dobutamine stress cardiac magnetic resonance (DSCMR) with dobutamine stress echocardiography (DSE) in patients with left bundle branch block (LBBB) and suspected coronary artery disease (CAD).

Background Noninvasive diagnosis of CAD in patients with pre-existent LBBB is difficult because single-photon emission computed tomography and stress echocardiography both have limitations. We hypothesized that a comprehensive DSCMR examination including cine, perfusion, and late gadolinium enhancement imaging would be more accurate than DSE, thus potentially reducing the number of unnecessary invasive coronary angiograms.

Methods We prospectively evaluated 82 consecutive patients with LBBB referred to our cardiology clinic for investigation of suspected CAD. All 82 patients underwent DSE, DSCMR, and invasive quantitative coronary angiography within 14 days. We compared the diagnostic accuracy of DSE, CMR cine imaging, the additive value of first-pass perfusion, and late gadolinium enhancement. In the comprehensive examination, a positive result was adjudged as the presence of either subendocardial or transmural late gadolinium enhancement with or without inducible peri-infarct ischemia or an inducible perfusion defect corresponding to an inducible regional wall motion abnormality.

Results CMR cine imaging (regional wall motion abnormalities) had higher specificity, negative predictive value, and overall diagnostic accuracy than did DSE (87.5% vs. 72.9%; 80.8% vs. 67.3%; and 80.4% vs. 72.0%, respectively), although sensitivity was the same (72.0%). The addition of first-pass stress perfusion and late gadolinium enhancement (scar) further improved diagnostic confidence (sensitivity 82.4%, specificity 95.8%, positive predictive value 93.3%, negative predictive value 88.5%, and diagnostic accuracy 90.2%).

Conclusions DSCMR is a safe procedure and has greater diagnostic accuracy than does DSE in assessing patients with suspected CAD and LBBB. A comprehensive examination with the addition of perfusion and late gadolinium enhancement to CMR cine imaging significantly boosted specificity and sensitivity, making DSCMR a reliable alternative to invasive quantitative coronary angiography in this group of patients.
Keyword Bundle branch block
Cardiac magnetic resonance
Coronary disease
Stress echocardiography
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Authors prepub title: "Comprehensive Dobutamine Stress MRI versus Dobutamine Stress Echocardiography in the Assessment of Patients with Left Bundle Branch Block and Suspected Coronary Artery Disease".

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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Created: Wed, 26 Feb 2014, 00:12:20 EST by Tony Stanton on behalf of Medicine - Princess Alexandra Hospital