Comparação das alterações da motilidade segmentar e da perfusão miocárdica durante o estresse pela dobutamina-atropina, pela ecocardiografia com contraste e pela ressonância magnética, na detecção de doença arterial coronária obstrutiva / Comparison of wall motion and myocardial perfusion abnormalities during dobutamine-atropine stress with myocardial contrast echocardiography and magnetic resonance imaging for the detection of obstructive coronary artery disease

Sandra Nívea dos Reis Saraiva Falcão

The detection of left ventricular (LV) wall motion abnormalities induced by pharmacological or physical stress has a well established role in the non-invasive determination of myocardial ischemia. However, following the temporal sequence of events in the ischemic cascate, perfusion heterogeneity is one of the earliest and may occur before wall motion abnormalities. In the last years, association between parameters has been demonstrated to improve the diagnoses of coronary artery disease (CAD) during cardiac stress tests. Microbubble-based contrast agent allows for better LV endocardial border delineation and analysis of myocardial perfusion during stress echocardiography. Cardiac magnetic resonance imaging (CMRI) is a technique that has been extensively used to investigate CAD, both for the analysis of wall motion and myocardial perfusion. However, the combination of these parameters has not been completely defined in the literature. The objectives of this study were: to determine the additional value of myocardial perfusion over wall motion analysis with real-time myocardial perfusion echocardiography (RTMPE) and CMRI and to compare, in the same group of patients, the diagnostic accuracy of RTMPE and CMRI using the same dobutamine-atropine stress protocol for detection of angiographically significant CAD. A total of 42 patients were studied (mean age of 59±7 years, 20 men) with clinical suspicion of CAD and indication of coronary angiography. All patients underwent dobutamine-atropine stress protocol during RTMPE and CMRI, with intervals of three days to three months apart. Perflutren contrast agent was used for perfusion analysis by RTMPE, and paramagnetic gadolinium-based contrast was used by CMRI, both injected intravenously. Wall motion and myocardial perfusion were determined by visual analysis both in RTMPE and CMRI using the 17-segment model of the Joint Committee of the American Heart Association. All patients underwent invasive coronary angiography within three months of stress tests. Significant CAD was defined as more than 50% of luminal stenosis determined by quantitative coronary angiography. Of the 42 studied patients, 25 (60%) had significant CAD. Among them, 10 had single-vessel and 15 had multivessel CAD. Analysis of wall motion and myocardial perfusion by RTMPE presented sensitivity of 72% and 88% and diagnostic accuracy of 80% and 88%, respectively, for the detection of significant CAD. Analysis of wall motion and myocardial perfusion by CMRI presented sensitivity of 80% and 92% and diagnostic accuracy of 80% and 88%, respectively, for the detection of significant CAD. The additional value of myocardial perfusion over wall motion for the diagnosis of CAD was assessed in a model that included wall motion and the association of wall motion plus myocardial perfusion both during RTMPE (2 of 16.16 versus 24.13, respectively) and CMRI (2 of 12.73 versus 27.4, respectively) with p<0.05 in both models. In conclusion, RTMPE and CMRI using the same dobutamine-atropine stress protocol had comparable diagnostic accuracies for the detection of angiographically significant CAD. Myocardial perfusion had additional value over wall motion analysis for the diagnosis of CAD, both at RTMPE and CMRI.

AUTOR(ES)

DATA DE PUBLICAÇÃO

RESUMO

ASSUNTO(S)

ACESSO AO ARTIGO

Documentos Relacionados