Related Experiment Video
Updated: Jun 6, 2026
Cardiac Stress Test Induced by Dobutamine and Monitored by Cardiac Catheterization in Mice
Published on: February 10, 2013
Head-to-head comparison of first-pass MR perfusion imaging during adenosine and high-dose dobutamine/atropine stress
Robert Manka1, Cosima Jahnke, Rolf Gebker
1Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany, manka@dhzb.de
Insights
Adenosine and dobutamine/atropine stress cardiac magnetic resonance (CMR) perfusion imaging show equal effectiveness in detecting coronary artery disease. Both methods accurately identify stress-induced perfusion deficits, offering comparable diagnostic capabilities for patients with suspected coronary artery disease.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Cardiology
- Medical Physics
Background:
- Coronary artery disease (CAD) diagnosis relies on accurate stress testing.
- Cardiac magnetic resonance (CMR) perfusion imaging is a key diagnostic tool.
- Comparing different pharmacological stressors in CMR is crucial for optimizing patient care.
Purpose of the Study:
- To directly compare the diagnostic performance of adenosine versus high-dose dobutamine/atropine stress in first-pass myocardial perfusion CMR.
- To evaluate the sensitivity and specificity of each stressor in detecting significant coronary artery stenosis.
- To assess the agreement between the two stress modalities in identifying stress-induced perfusion deficits.
Main Methods:
- Forty-one patients with suspected or known CAD underwent 1.5 Tesla CMR perfusion imaging on consecutive days.
- Day 1: Adenosine stress (140 μg/kg/min) with Gd-DTPA contrast.
- Day 2: Dobutamine/atropine stress (up to 85% max heart rate) with identical CMR sequence.
- Quantitative coronary angiography served as the reference standard (≥50% stenosis).
Main Results:
- Twenty-five patients (61%) had significant coronary stenoses.
- Both adenosine and dobutamine/atropine stress achieved high sensitivity (92%) and specificity (75%) for stenosis detection on a per-patient basis.
- Near-perfect agreement (kappa 1.0 patient-based, 0.92 segment-based) was observed between the two stressors for identifying perfusion deficits.
- Both stressors induced comparable extents of ischemic reactions.
Conclusions:
- Adenosine and dobutamine/atropine stress CMR perfusion imaging demonstrate equivalent efficacy in detecting stress-induced myocardial perfusion deficits.
- Dobutamine/atropine stress CMR is a valid alternative to adenosine stress, particularly for patients with contraindications to vasodilator agents.
- Both methods provide reliable diagnostic information for patients with suspected or known coronary artery disease.
Abstract:
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.
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
01:21Imaging Studies for Cardiovascular System IV: CMRI