Prediction of Cardiac Events in Patients With Reduced Left Ventricular Ejection Fraction With Dobutamine Cardiovascular Magnetic Resonance Assessment of Wall Motion Score Index
Erica Dall'Armellina, MD*,
Timothy M. Morgan, PhD ,
Sangeeta Mandapaka, MD*,
William Ntim, MD, FACC*,
J. Jeffrey Carr, MD, FACC, ,
Craig A. Hamilton, PhD ,
John Hoyle, MD, FACC*,
Hollins Clark, MD,
Paige Clark, MD,
Kerry M. Link, MD, FACC,
Doug Case, PhD and
W. Gregory Hundley, MD, FACC*,,*
* Department of Internal Medicine (Cardiology Section) at the Wake Forest University School of Medicine, Winston-Salem, North Carolina
Department of Biostatistics at the Wake Forest University School of Medicine, Winston-Salem, North Carolina
Department of Biomedical Engineering at the Wake Forest University School of Medicine, Winston-Salem, North Carolina
Department of Radiology at the Wake Forest University School of Medicine, Winston-Salem, North Carolina.
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Figure 1 Predictive Value of Stress-Induced Change in WMSI for Hard and Any Events
Panel A demonstrates the wall motion score index (WMSI) (y-axis) during the 3 phases of dobutamine infusion (rest, low-dose infusion, and after peak stress). Within each stage, the mean ± SE of the estimate is shown. As noted, for any events, the difference in WMSI from low dose to peak stress was higher in those experiencing any events (A). As shown in panel B, the resting and peak WMSI was higher in patients experiencing myocardial infarction and cardiac death. CMR = cardiovascular magnetic resonance; DBT = dobutamine.
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Figure 2 Event-Free Survival After Dobutamine Stress
Kaplan-Meier event-free survival curves in patients with resting left ventricular dysfunction who did or did not experience an increase in wall motion score index (WMSI) during dobutamine cardiovascular magnetic resonance stress. Compared with patients with no evidence of stress-induced increase of WMSI, event-free survival was significantly lower in patients with increased WMSI either for any event (p = 0.002, A) or for hard events (p = 0.05, B).
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Figure 3 Event-Free Survival by Gender
Kaplan-Meier any event-free survival curves in men and women with resting left ventricular dysfunction who did or did not experience an increase in wall motion score index (WMSI) during dobutamine cardiovascular magnetic resonance (DCMR) stress. Both men and women who experienced an increase in WMSI during DCMR had a lower event-free survival at 60 months (p = 0.008 for men and p = 0.15 for women) with a similar trend for both genders (p = 0.64). HR = hazard ratio.
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Figure 4 Multivariate Determinants of Cardiac Events
Multivariate analyses displaying hazard ratios ± 95% confidence intervals (x-axis) for developing myocardial infarction (MI) or cardiac death. This model includes risk factors for coronary arteriosclerosis and MI. As shown, a stress-induced increase of wall motion score index (WMSI) is an independent predictor of MI and cardiac death after accounting for these variables. BMI = body mass index; CMR = cardiovascular magnetic resonance; LVEF = left ventricular ejection fraction.
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Figure 5 Relationship Between Cardiac Events and LVEF
Hazard ratio of experiencing a hard event (A) or any event (B) as a function of left ventricular ejection fraction (EF). Each point represents an event experienced by a study participant. The hazard values are relative to a patient without a dobutamine-induced increase in wall motion score index (WMSI) and a resting left ventricular EF = 40%.
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