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Dobutamine Cardiac Magnetic Resonance Results Predict Cardiac Prognosis in Women With Known or Suspected Ischemic Heart Disease

Eric L. Wallace, DO^_*, Timothy M. Morgan, PhD, Thomas F. Walsh, MD^_*, Erica Dall'Armellina, MD^_*, William Ntim, MD, FACC^_*, Craig A. Hamilton, PhD, W. Gregory Hundley, MD, FACC^_*,,_*

^_* Department of Internal Medicine (Cardiology Section), Wake Forest University School of Medicine, Winston-Salem, North Carolina
Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina

^_* Reprint requests and correspondence: Dr. W. Gregory Hundley, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157–1045 (Email: ghundley{at}wfubmc.edu).

Objectives: The purpose of this study was to determine the prognostic utility of dobutamine cardiac magnetic resonance (DCMR) stress test results in women.

Background: To date, the preponderance of studies reporting the utility of DCMR stress results for predicting cardiac prognosis have been performed in men. We sought to determine the utility of DCMR results for predicting cardiac prognosis in women.

Methods: Two hundred sixty-six consecutively referred women underwent DCMR in which left ventricular wall motion (LVWM) was assessed at rest and after intravenous dobutamine and atropine. Inducible LVWM abnormalities were identified during testing. Women were contacted to determine the post-DCMR occurrence of a cardiac event. All events were substantiated according to defined criteria and then were verified after a thorough medical record review by individuals blinded to testing data.

Results: Women were contacted an average of 6.2 ± 1.6 (median 6.2, range 0.8 to 10.4) years after DCMR; 27% of the women experienced an inducible LVWM abnormality during testing. In those with and without inducible LVWM abnormalities, the proportion of women with cardiac events were 63% versus 30%, respectively, (hazard ratio [HR]: 2.7; 95% confidence interval [CI]: 1.8 to 4.3 for the presence of inducible LVWM abnormalities p < 0.0001). The proportion of women with myocardial infarction (MI) and cardiac death were 33.3% and 7.5%, respectively. This resulted in a HR for MI and cardiac death of 4.1 (95% CI: 2.2 to 9.4) for those with versus those without inducible LVWM abnormalities; p < 0.0001. A subgroup analysis was performed in women without a history of coronary artery disease and in those with LVWM abnormalities, DCMR remained an adverse predictor of cardiac events (HR: 4.0, 95% CI: 1.8 to 9.0, p = 0.003).

Conclusions: Inducible LVWM abnormalities during DCMR predict cardiac death and MI in women. Similar to men, these results indicate that DCMR is a valuable noninvasive stress imaging modality for identifying cardiac risk in women with known or suspected ischemic heart disease.

Key Words: women • prognosis • magnetic resonance

Abbreviations and Acronyms   CI = confidence interval   DCMR = dobutamine cardiac magnetic resonance   DSE = dobutamine stress echocardiography   HR = hazard ratio   LVEF = left ventricular ejection fraction   LVWM = left ventricular wall motion   MI = myocardial infarction