Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany,
Int J Cardiovasc Imaging. 2011 Oct;27(7):995-1002. doi: 10.1007/s10554-010-9748-3. Epub 2010 Nov 19.
To directly compare the stressor capabilities of adenosine and high-dose dobutamine/atropine using first pass myocardial perfusion magnetic resonance imaging. Fourty-one patients with suspected or known coronary artery disease underwent cardiac magnetic resonance (CMR) perfusion imaging at 1.5 Tesla on two consecutive days prior to invasive coronary angiography. On day 1 a standard CMR perfusion protocol during adenosine stress was carried out (adenosine infusion with 140 μg/kg/min, 0.1 mmol/kg Gd-DTPA). On day 2, the identical CMR perfusion sequence was repeated during a standard high-dose dobutamine/atropine stress protocol at rest and during target heart rate (85% of maximum age-predicted heart rate). Stress-inducible perfusion deficits were evaluated visually regarding presence and transmural extent. Quantitative coronary angiography served as the reference standard with significant stenosis defined as ≥50% luminal diameter reduction. Twenty-five patients (61%) had significant coronary stenoses. Adenosine and dobutamine stress CMR perfusion imaging resulted in an equally high sensitivity and specificity for the stenosis detection on a per patient basis (92 and 75% for both stressors, respectively). Agreement of both stressors with regard to the presence or absence of stress-inducible perfusion deficits was nearly perfect using patient- and segment based analysis (kappa 1.0 and 0.92, respectively). Adenosine and dobutamine/atropine stress CMR perfusion imaging are equally capable to identify stress inducible deficits and resulted in an almost identical extent of ischemic reactions. Though adenosine stress CMR perfusion imaging is widely employed, dobutamine stress CMR perfusion represents a valid alternative and may be particularly useful in patients with contraindications to vasodilator testing.
通过首次通过心肌灌注磁共振成像直接比较腺苷和高剂量多巴酚丁胺/阿托品的应激能力。41 名疑似或已知冠心病患者在侵入性冠状动脉造影前连续两天在 1.5 Tesla 上进行心脏磁共振（CMR）灌注成像。第 1 天，在腺苷应激期间进行标准 CMR 灌注方案（腺苷输注 140μg/kg/min，0.1mmol/kg Gd-DTPA）。第 2 天，在休息和目标心率（最大年龄预测心率的 85%）期间，通过标准高剂量多巴酚丁胺/阿托品应激方案重复相同的 CMR 灌注序列。根据存在和透壁程度，通过视觉评估应激诱导的灌注缺陷。定量冠状动脉造影作为参考标准，定义为≥50%的管腔直径减少的显著狭窄。25 名患者（61%）有明显的冠状动脉狭窄。腺苷和多巴酚丁胺应激 CMR 灌注成像在患者个体基础上对狭窄检测具有相同的高敏感性和特异性（两种应激剂分别为 92%和 75%）。使用基于患者和节段的分析，两种应激剂在存在或不存在应激诱导的灌注缺陷方面的一致性几乎是完美的（kappa 值分别为 1.0 和 0.92）。腺苷和多巴酚丁胺/阿托品应激 CMR 灌注成像均能够识别应激诱导的缺陷，并导致几乎相同程度的缺血反应。虽然腺苷应激 CMR 灌注成像广泛应用，但多巴酚丁胺应激 CMR 灌注是一种有效的替代方法，对于血管扩张剂试验有禁忌的患者可能特别有用。
