Why the study?
Patients with CABG have an elevated risk of major adverse cardiac events, but there is a lack of data regarding the safety of high-dose DCMR in this population.
Does high-dose dobutamine stress cardiovascular magnetic resonance imaging increase adverse events in patients with prior coronary artery bypass grafting compared to matched controls without prior CABG?
Does high-dose dobutamine stress cardiovascular magnetic resonance imaging increase adverse events in patients with prior coronary artery bypass grafting compared to matched controls without prior CABG?
Dobutamine stress cardiovascular magnetic resonance imaging is safe in patients with prior coronary artery bypass grafting, with adverse event rates comparable to matched controls.
Answers are grounded in this paper and cite their sources.
Comparable adverse event rates support safety of dobutamine stress CMR post-CABG; leaves open need for prospective confirmation.
BACKGROUND: Patients with coronary artery bypass grafts (CABG) face an elevated risk of major adverse cardiac events. High-dose dobutamine stress cardiovascular magnetic resonance (DCMR) imaging is a well-established technique to detect hemodynamically significant coronary artery disease. However, there is a lack of data regarding the safety of DCMR in patients with CABG. This study aims to evaluate the safety of DCMR in patients with CABG. METHODS: We retrospectively studied patients after CABG who subsequently underwent DCMR between November 2008 and July 2018. Side effects, defined as adverse events and minor symptoms, during DCMR were analyzed and compared to 200 individuals matched for age, sex, and body mass index without prior CABG undergoing DCMR. RESULTS: Three hundred and thirty-six patients (70 ± 9 years, 85% men (284/336)) were identified. Adverse events occurred in 35 CABG patients (10% (35/336)) and 18 controls (9% (18/200), p = 0.595). A drop of systolic blood pressure (SBP) >40 mmHg (12 patients), non-sustained ventricular tachycardia (6 patients), increase in SBP >200 mmHg (5 patients), monomorphic premature ventricular contractions (PVC) (2 patients), bigeminy (2 patients), left bundle-branch block (2 patients), as well as tachycardiac paroxysmal atrial fibrillation, bradycardia, supraventricular tachycardia, couplets/triplets, and sinus arrhythmia in 1 patient each occurred in the study group. In addition, one patient was hospitalized due to tachycardiac paroxysmal atrial fibrillation and transient ischemic attack. Twenty-nine (8.7% (29/336)) examinations in the study group were aborted because of either chest pain, dyspnea, nausea, dizziness, a drop of SBP, arrhythmias, tachycardiac paroxysmal atrial fibrillation, monomorphic PVCs, or non-sustained ventricular tachycardia. The rate of aborted examination was comparable to the control group (7.5% (15/(200), p = 0.631). Univariable logistic regression analysis revealed that female sex (odds ratio [OR] 2.21, 95% confidence intervals [CI] 1.2-4.3, p = 0.017) and inducible ischemia (OR 3.50, 95% CI 2.0-6.0, p < 0.001) were associated with an increased risk of side effects during DCMR. CONCLUSION: Dobutamine stress CMR did not show a relevant increase in adverse events in patients with prior CABG compared to patients without prior CABG. Female sex and dobutamine-induced myocardial ischemia are associated with side effects during DCMR.
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Heins et al. (2024) studied this question.
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