Volume 13 Supplement 1

Abstracts of the 2011 SCMR/Euro CMR Joint Scientific Sessions

Open Access

Dobutamine stress cardiovascular MR in clinical practice: a single centre experience

  • SK Khambekar1,
  • M Byrant1,
  • JS Shambrook1,
  • CP Peebles1,
  • IW Brown1 and
  • SP Harden1
Journal of Cardiovascular Magnetic Resonance201113(Suppl 1):P227

https://doi.org/10.1186/1532-429X-13-S1-P227

Published: 2 February 2011

Introduction

Dobutamine stress cardiovascular magnetic resonance (DCMR) is a robust tool for determining the presence of inducible ischaemia in patients with known or suspected coronary artery disease (CAD).

Purpose

To assess the safety of DCMR in clinical practice in a tertiary referral centre in the UK.

Methods

We retrospectively studied all DCMR scans performed between May 2006 and March 2009.

CMR Protocol

CMR studies were performed using a 1.5 T (Siemens Avanto) clinical CMR scanner. After a full functional assessment using steady state free precession (SSFP) cine imaging, three short axis images together with the three long axis (2-, 3- and 4- chamber) images were selected and these were then acquired at each dose increment during a standard dobutamine-atropine protocol. Dobutamine was infused in 10 mcg/ kg/ min increments up to a maximum of 40 mcg/ kg/ min. Initial 5 mcg/ kg/ min increments were used where there was a wall motion abnormality at rest. The protocol was continued until target heart rate was achieved or until there was a recognised indication to stop prior to reaching target heart rate. Side effects and complications were recorded.

Results

Out of 455 patients, 21(4.6%) patients were unable to undergo the procedure (claustrophobia, MR incompatible device in situ)

434 scans were performed in patients with a mean age of 64 years (range 13-86). 419 patients had a full dose study to assess for inducible ischaemia while 15 patients had a low dose protocol to determine myocardial viability.

The average dose of dobutamine required for each full dose study was 24 + 9 micrograms/ kg/ min with additional atropine used in 119 (27.4%) patients. Target heart rate was achieved in 334 (79%) patients.

Of the 85 patients who failed to achieve target heart rate, 37(43%) developed significant chest pain, requiring the infusion to be stopped. Chest pain was the commonest cardiac side effect but in only 20% of these patients was the scan stopped early. 5 patients needed in-patient overnight observation for hypotension (2), broad complex tachycardia (1) and fast AF (2). None of these had a significant rise in troponin.

Minor non-cardiac side effects occurred in 18 (4%) patients (eg nausea).

Conclusions

Our experience suggests DCMR is a safe and feasible technique in routine clinical practice for assessing patients with suspected or known CAD and has a low complication rate.

Authors’ Affiliations

(1)
Southampton University Hospital NHS Trust

Copyright

© Khambekar et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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