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LV geometry influential in DSMR-wall motion accuracy

Gebker R. Circ Cardiovasc Imaging. 2010;3:507-514.

Issue: November 2010

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Left ventricular geometry influenced the effectiveness of dobutamine stress magnetic resonance-wall motion for the detection of coronary artery disease, study findings indicated. In addition, for patients with concentric remodeling and concentric hypertrophy, additional first-pass perfusion imaging improved diagnostic accuracy for detecting coronary artery disease.

Researchers performed combined dobutamine stress magnetic resonance (DSMR)-wall motion and DSMR-perfusion imaging in a single session in patients (n=187) scheduled for invasive coronary angiography. Then, they classified patients into four categories based on LV mass (normal: ≤81 g/m² in men, ≤62 g/m² in women) and relative wall thickness (normal,<0.45): normal geometry (normal mass, normal relative wall thickness), concentric remodeling (normal mass, increased relative wall thickness), concentric hypertrophy (increased mass, increased relative wall thickness) and eccentric hypertrophy (increased mass, normal relative wall thickness). Significant CAD was defined as at least 70% stenosis.

Study results showed that in patients with increased LV concentricity, sensitivity and accuracy of DSMR-wall motion were significantly reduced (63% sensitivity, 73% accuracy; P<.05) compared with patients without increased LV concentricity (90% sensitivity, 88% accuracy; P<.05). Additionally, the accuracy of DSMR-wall motion vs. DSMR-perfusion was superior in patients with eccentric hypertrophy (90% vs. 85%; P<.05), whereas DSMR-perfusion had higher accuracy in patients with concentric hypertrophy (82% vs. 71%; P<.05).

“This study highlighted the influence of different LV geometric patterns on diagnostic accuracy of DSMR-wall motion and the potential benefit of performing additional first-pass DSMR-perfusion imaging,” researchers concluded. “We thus recommend adding DSMR-perfusion to a routine stress protocol in patients with increased LV concentricity.”

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