Cine risonanza magnetica con dobutamina dopo infarto del miocardio

Purpose: Dobutamine Cine MRI is a new diagnostic imaging technique in the pretreatment (revascularization) assessment of myocardial infarction patients. We report the results of a comparative study of the diagnostic yield of dobutamine Cine MRI with that of stress echocardiography in the assessment of viable myocardium. We also propose a new method for analysis of Cine MR images, employing digital subtraction, aimed at decreasing subjectivity in the quantitative assessment of myocardial wall thickening. Materials and methods. Twenty-six patients (21 men and 5 women) with a history of myocardial infarction who were scheduled for revascularization were submitted to stress echocardiography and dobutamine Cine MRI to evaluate contractile recovery of the segments considered akinetic or hypokinetic at baseline echocardiography. Dobutamine was administered in growing doses (5, 10, 15 γ/kg/min). We considered 16 segments of the left ventricle in each patient. We performed a quantitative analysis of systolic wall thickening on individual Cine MR frames both by manual measurements and by digital subtraction. Results. In the 416 segments studied, we found 307 normokinetic, 64 scarred and 45 viable segments with stress echocardiography, versus 302 normokinetic, 83 scarred and 31 viable segments with dobutamine MRI. Wall thickening analysis on Cine MR images showed 268 normal, 68 scarred and 80 viable segments, versus 274 normal, 58 scarred and 84 viable segments with digital subtraction. Three months after revascularization 15 patients were examined to check contractile recovery of the segments considered as viable. Echocardiography had 79% sensitivity and 97% specificity, while Cine MRI had 96% and 86%, respectively. Quantitative assessment of systolic wall thickening by Cine MRI and digital subtraction had 96% sensitivity and 91% specificity, with no statistically significant differences between the two techniques. In patients with anteroseptal wall myocardial infarction stress echocardiography had 75% sensitivity and 97% specificity. In the subgroup of 13 patients with diaphragmatic or inferior wall infarction echocardiography sensitivity dropped to 68%, versus 96% of Cine MRI, but its specificity was higher namely 97% versus 86%. Conclusions. In anteroseptal infarction, echocardiography permits to distinguish viable myocardium and scarred myocardial tissue with good sensitivity and specificity, but Cine MRI performs better. In infero-lateral or diaphragmatic infarction, Cine MRI has much higher sensitivity than stress echocardiography and thus makes the technique of choice to evaluate viable myocardium in these sites. The digital subtraction technique is as accurate as manual measurements, but reduces the error rate and permits quicker evaluation, particularly in subendocardial thickening.