disease in women imaging for the detection of coronary artery Dobutamine stress magnetic resonance

Background Dobutamine stress magnetic resonance (DSMR) imaging represents an excellent imaging approach for the detection of coronary artery disease (CAD). However, most studies have predominantly reported the utility of DSMR in men. Objective To evaluate the diagnostic value of DSMR in men and women. Methods and results High-dose dobutamine/atropine stress magnetic resonance imaging was performed and new or worsening wall motion abnormalities evaluated in 745 consecutive patients (204 women, 541 men). Invasive coronary angiography was performed within 30 days and served as the reference standard ($70% stenosis). DSMR was technically successful and had diagnostic image quality in all patients except one woman and three men (p1⁄4NS). In the absence of ischaemia, target heart rate was not reached in 9.3% of women and 8.5% of men (P1⁄4NS) despite maximum pharmacological infusion (1% and 2.2%, respectively, p1⁄4NS) or owing to limiting side effects (8.3% and 6.3%, respectively, p1⁄4NS). Diagnostic values (sensitivity/specificity/ accuracy) for the detection of significant coronary stenoses were similar for men (86%/83%/85%) and women (85%/86%/85%). There was no gender-based difference in regional diagnostic accuracy of DSMR for all three coronary vascular territories in patients with single-vessel CAD (81% vs 81%, p1⁄4NS, respectively). Conclusion The diagnostic capability of DSMR for the detection of haemodynamically relevant, obstructive CAD is independent of gender. Cardiovascular disease is the most common cause of death amongwomen.Although significant progress has been made in the area of gender-specific cardiovascular research over the past decade, the noninvasive diagnosis of coronary artery disease (CAD) in women remains challenging. Exercise electrocardiographyhas an inferior sensitivity for the detection of CAD in women, in part owing to a lower prevalence of CAD and a lower exercise capability of women compared with men. Most studies on exercise and dobutamine stress echocardiography have reported similar diagnostic results in both genders. 4 Dobutamine stress magnetic resonance (DSMR) has been established as an accurate method for the diagnosis of CAD and has its greatest benefit in patients who are unsuitable for stress echocardiography. However, in most published diagnostic studies, patients were predominantly men. The aim of this study was to assess the possible influence of gender on the diagnostic value ofDSMR. MATERIALS AND METHODS Patient population The study was approved by the institutional review board at the Charité University School of Medicine and written informed consent was given by all patients. DSMRwas performed prospectively in 745 consecutive patients with suspected and known CAD scheduled for clinically indicated coronary angiography. Patients with contraindications to either MRI (non-compatible biometallic implants or claustrophobia) or dobutamine (acute coronary syndrome, severe hypertension, significant aortic stenosis, myocarditis, endocarditis, pericarditis), and patients with arrhythmia were not considered for study inclusion. All patients were instructed to refrain from b blockers and antianginal medication (nitrates, calcium antagonists) 24 h before the MR study. MRI MRI was performed with the patient in the supine position using a 1.5 T MR scanner (Philips Intera CV, Best, The Netherlands) equipped with a Nova gradient system (33 mT/m; 160 mT/m/ms) based on Philips release 11. A five-element cardiac synergy coil was used for signal reception. Cardiac synchronisation was performed by using four electrodes placed on the left anterior hemithorax (vector electrocardiogram), and scans were triggered on the R wave of the ECG. Cardiac standard geometries (three short-axis views, four-, twoand three-chamber views) were acquired at rest and during each dobutamine stress level. Dobutamine stress MR protocol Dobutamine was infused via an antecubital vein starting at a dose of 10 mg/kg/min and was increased by 10 mg/kg/min every 3 min to a maximum of 40 mg/kg/min. Atropine (up to 2 mg) was given to patients not achieving 85% of agepredicted maximum heart rate at peak dobutamine dose. Termination criteria were as previously published. The test was interrupted if severe chest pain, significant ventricular or supraventricular arrhythmia, hypertension (RR >240/120 mm Hg), a systolic blood pressure decrease >40 mm Hg, or any intolerable side effect occurred during the test. If chest pain, arrhythmias or any intolerable side effects occurred during testing and did not resolve after termination of dobutamine infusion, intravenous esmolol (50e100 mg) was given additionally. MR image analysis Left ventricular hypertrophy (LVH) was defined as an interventricular septum thickness $12 mm in German Heart Institute Berlin, Germany Correspondence to Dr R Gebker, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; gebker@dhzb.de Accepted 4 August 2009 Published Online First 16 August 2009 616 Heart 2010;96:616e620. doi:10.1136/hrt.2009. 175521 Cardiac imaging and non-invasive testing group.bmj. com on April 12, 2010 Published by heart.bmj. com Downloaded from