Adverse effect of increased left ventricular wall thickness on five year outcomes
of patients with negative dobutamine stress
Abstract
Background
To determine if patients without dobutamine induced left ventricular wall motion abnormalities
(WMA) but an increased LV end-diastolic wall thickness (EDWT) exhibit a favorable cardiac prognosis.
Background
To determine if patients without dobutamine induced left ventricular wall motion abnormalities
(WMA) but an increased LV end-diastolic wall thickness (EDWT) exhibit a favorable cardiac prognosis.
Results
Between 1999 and 2001, 175 patients underwent a dobutamine stress cardiovascular magnetic
resonance (DCMR) procedure utilizing gradient-echo cines. Participants had a LV ejection fraction >55% without evidence of an inducible WMA during peak dobutamine/atropine stress.
After an average of 5.5 years, all participants were contacted and medical records were reviewed to determine the post-DCMR occurrence of cardiac death, myocardial infarction (MI), and unstable angina (USA) or congestive heart failure (CHF) warranting hospitalization. In a multivariate analysis, that took into account Framingham and other risk factors associated with cardiac events, a cine gradient-echo derived LV EDWT 12mm was associated independently with an increase in cardiac death and MI (HR 6.0, p=0.0016), and the combined end point of MI, cardiac death, and USA or CHF warranting hospitalization (HR 3.0, p=0.0005).
Between 1999 and 2001, 175 patients underwent a dobutamine stress cardiovascular magnetic
resonance (DCMR) procedure utilizing gradient-echo cines. Participants had a LV ejection fraction >55% without evidence of an inducible WMA during peak dobutamine/atropine stress.
After an average of 5.5 years, all participants were contacted and medical records were reviewed to determine the post-DCMR occurrence of cardiac death, myocardial infarction (MI), and unstable angina (USA) or congestive heart failure (CHF) warranting hospitalization. In a multivariate analysis, that took into account Framingham and other risk factors associated with cardiac events, a cine gradient-echo derived LV EDWT 12mm was associated independently with an increase in cardiac death and MI (HR 6.0, p=0.0016), and the combined end point of MI, cardiac death, and USA or CHF warranting hospitalization (HR 3.0, p=0.0005).
Conclusions
Similar to echocardiography, CMR measures of increased LV wall thickness should be considered a risk factor for cardiac events in individuals receiving negative reports of inducible ischemia after dobutamine stress. Additional prognostic studies of the importance of LV wall thickness and mass measured with steady-state free precession techniques are warranted.
Journal of Cardiovascular Magnetic Resonance 2009, 11:25.
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