Prognostic Value of High Dose Dobutamine Stress Magnetic Resonance Imaging (DS-Prognosis)
Prognostic Value of High Dose Dobutamine Stress Magnetic Resonance in Patients With Ischemic Heart Disease. Assessment of Myocardial Perfusion and Wall Motion.
High-dose dobutamine/atropine stress cardiac magnetic resonance imaging (DS-MRI) has been incorporated in daily clinical practice for the detection of ischemic heart disease.
Thus, wall motion abnormalities (WMA) during stress, precede the development of ST-segment depression on ECG and of anginal symptoms and aid in the detection of anatomically significant coronary artery disease (CAD).
DS-MRI offers the possibility to integrate myocardial perfusion and wall motion analysis in a single examination. In this regard, recent data suggest that the assessment of myocardial wall motion and perfusion during a single session may enhance the sensitivity of the technique for the diagnosis of CAD.
However, to date limited data is available on the prognostic value of high-dose DS-MRI in large patient cohorts, treated according to current guidelines.
Assessment of long-term outcome of DS-MRI is important because this test may identify both high-risk patients, who would benefit from invasive diagnostic and therapy, and lower-risk patients in whom additional procedures and intensive medical follow-up are not required.
In the present study we aim to determine the value of wall motion and perfusion assessment during high-dose dobutamine/atropine MRI in predicting cardiac events.
In addition, the incremental value of the MR-stress testing results was assessed (inducible wall motion, perfusion abnormalities and the combination of both) after the consideration of traditional clinical risk factors and baseline ejection fraction.
調査の概要
状態
条件
詳細な説明
Background: High-dose dobutamine stress cardiac magnetic resonance imaging (DS-MRI) is incorporated in daily clinical practice for the detection of coronary artery disease (CAD). Purpose: To determine the value of wall motion and perfusion assessment during DS-MRI for the prediction of cardiac events in a large patient cohort.
Methods:
Cardiovascular MR-Examination. Patients are examined in a clinical 1.5-T whole-body MR-scanner Achieva system (Philips Medical Systems, Best, The Netherlands) using a 5-element cardiac phased-array receiver coil. Cardiovascular MR-images were acquired at rest and during a standardized high-dose dobutamine/atropine protocol involving short breath holds, and using a vector electrocardiogram for R-wave triggering11. Electrocardiographic rhythm and symptoms were monitored continuously, and blood pressure was measured every 3 minutes.
Follow-up Data. Personnel unaware of the stress testing results contacts each subject or an immediate family member and the date of this contact was used for calculating the follow-up time duration. Outcome data iscollected from a standardized questionnaire and determined from patient interviews at the outpatient clinic or by telephone interviews. Reported clinical events are confirmed by review of the corresponding medical records in our electronic Hospital Information System (HIS), contact with the general practitioner, referring cardiologist or the treating hospital. Cardiac death and nonfatal myocardial infarction are registered as major cardiac events. Cardiac death is defined as death from any cardiac cause (lethal arrhythmia, myocardial infarction, or congestive heart failure) or sudden unexpected death occurring without another explanation. Myocardial infarction is defined by angina of >30 minutes duration and either ST segment elevation of ≥2mm in 2 consecutive ECG leads or a rise in troponin T of ≥0.03µg/l.
Other events include clinically indicated coronary arterial revascularization by percutaneous coronary angioplasty (PCI) or coronary artery bypass graft (CABG).
In case of 2 simultaneous cardiac events, the worst event was selected (cardiac death>non-fatal myocardial infarction>revascularization).
研究の種類
入学 (実際)
連絡先と場所
研究場所
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Heidelberg、ドイツ、69120
- University of Heidelberg, Department of Cardiology
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
サンプリング方法
調査対象母集団
説明
Inclusion Criteria:
- Written informed consent before the MR-examination
Exclusion Criteria:
- Non-sinus rhythm, unstable angina, severe arterial hypertension (>200/120 mmHg), moderate or severe valvular disease and general contraindications to MRI (implanted pacemakers or defibrillators, intracranial metal)
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 観測モデル：コホート
- 時間の展望：見込みのある
コホートと介入
グループ/コホート |
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1
Patients with suspected CAD
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2
Patients with known CAD and suspected ischemia.
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
時間枠 |
|---|---|
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Cardiac death and nonfatal myocardial infarction (MACEs)
時間枠：2-5 years of follow-up
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2-5 years of follow-up
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二次結果の測定
結果測定 |
時間枠 |
|---|---|
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Late revascularization (90 days after the MR-examination)
時間枠：2-5 yrs.
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2-5 yrs.
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協力者と研究者
スポンサー
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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