Purpose of this study was to assess the additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress Cardiac-MR (CMR). Dobutamine Stress CMR was performed in 115 patients with an inconclusive diagnosis of myocardial ischemia on a 1.5 T system (Magnetom Avanto, Siemens Medical Systems). Three short-axis cine and grid series were acquired during rest and at increasing doses of dobutamine (maximum 40 microg/kg/min). On peak dose dobutamine followed immediately by a first pass myocardial perfusion imaging sequence. Images were graded according to the sixteen-segment model, on a four point scale. Ninety-seven patients showed no New (Induced) Wall Motion Abnormalities (NWMA). Perfusion imaging showed absence of perfusion deficits in 67 of these patients (69%). Perfusion deficits attributable to known previous myocardial infarction were found in 30 patients (31%). Eighteen patients had NWMA, indicative for myocardial ischemia, of which 14 (78%) could be confirmed by a corresponding perfusion deficit. Four patients (22%) with NWMA did not have perfusion deficits. In these four patients NWMA were caused by a Left Bundle Branch Block (LBBB). They were free from cardiac events during the follow-up period (median 13.5 months; range 6-20). Addition of first-pass myocardial perfusion imaging during peak-dose dobutamine stress CMR can help to decide whether a NWMA is caused by myocardial ischemia or is due to an (inducible) LBBB, hereby preventing a false positive wall motion interpretation.

译文

:本研究的目的是评估在多巴酚丁胺应激性心肌病(CMR)峰值剂量期间首过心肌灌注显像的附加价值。多巴酚丁胺应激CMR在115例1.5 T系统(Magnetom Avanto,西门子医疗系统)上诊断为心肌缺血的患者中进行。在休息期间和增加剂量的多巴酚丁胺(最大40微克/公斤/分钟)下获得了三个短轴电影和栅格系列。在多巴酚丁胺达到峰值剂量后,立即进行首遍心肌灌注成像序列。图像根据十六段模型以四点标度进行分级。 97位患者未显示新的(诱发的)壁运动异常(NWMA)。灌注成像显示这些患者中有67位(69%)没有灌注不足。 30名患者(31%)发现可归因于先前已知的心肌梗塞的灌注不足。 18例患者有NWMA,提示有心肌缺血,其中14例(78%)可通过相应的灌注不足来确认。 NWMA的四名患者(22%)没有灌注不足。在这四例患者中,NWMA是由左束支传导阻滞(LBBB)引起的。在随访期间(中位数13.5个月;范围6-20),他们没有发生心脏事件。在峰值剂量多巴酚丁胺应激CMR期间增加首过心肌灌注显像可以帮助确定NWMA是由心肌缺血引起还是由(诱导性)LBBB引起,从而防止了假阳性的壁运动解释。

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