P1044Feasibility and safety of dobutamine stress CMR for cardiac evaluation of patients with PAD


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Abstract

Purpose: Medical, surgical or interventional treatment for each identified patient being at high risk for undesirable cardiovascular events is warranted to decrease coronary disease mortality in this subgroup of patients. Due to the systemic nature of the atherosclerosis and because of the typical existence of multiplex lesions, the risk of coronary events is high in patients with peripheral arterial disease (PAD). Cardiac risk assessment of these patients with conventional noninvasive methods is a challenge. The aim of this study was to analyze the feasibility and the risks of dobutamine stress cardiovascular magnetic resonance imaging (MRI) for cardiac evaluation of patients with PAD.Methods: 25 patients with peripheral artery disease (mean±SD age 64.8±7.2 years) were studied prospectively with dobutamine stress cardiovascular MRI. To attain the 0.85 × (220 – age) target heart rate, the dose of dobutamine was elevated up to 40 μg/kg/min and supplemented with 0.25 mg/min Atropine up to 1 mg if required. The stress had been terminated before target heart rate was reached if inducible wall-motion abnormalities appeared or angina occurred. Following stress, Gd(DTPA) was given and late gadolinium enhancement (LGE) MRI was implemented. MRI images were analysed independently by two senior cardiologists experienced in cardiac imaging who were blinded to the clinical data of the patients.Results: The protocol was completed by all of 25 patients. The target heart rate was attained in 96.0% of the studies. Technical problems occurred rarely during MRI examinations. No serious adverse event occurred. The image quality scores (1-4) for all ventricular wall segments were high (median, interquartile range) (4 [4-4]). Seven patients (28.0%) have inducible wall motion abnormality. Interobserver agreement was almost perfect for wall motion scores (κ=0.90, p<0.0001). Late gadolinium enhancement was detectable in 6 cases (24.0%) of the studies.Conclusions: Dobutamine stress cardiovascular MRI is feasible and safe for the noninvasive cardiac assessment of patients with PAD.

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