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Updated: May 1, 2026
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Published on: February 10, 2013
Comprehensive dobutamine stress CMR versus echocardiography in LBBB and suspected coronary artery disease
Ify Mordi1, Tony Stanton2, David Carrick1
1British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
Insights
Dobutamine stress cardiac magnetic resonance (DSCMR) offers superior diagnostic accuracy compared to dobutamine stress echocardiography (DSE) for detecting coronary artery disease (CAD) in patients with left bundle branch block (LBBB). This advanced imaging technique can reduce unnecessary invasive procedures.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Accuracy
- Noninvasive Cardiology
Background:
- Diagnosing coronary artery disease (CAD) in patients with left bundle branch block (LBBB) presents challenges for traditional noninvasive methods like single-photon emission computed tomography and stress echocardiography.
- Left bundle branch block can obscure or mimic findings of ischemia on standard cardiac imaging modalities.
- There is a need for more accurate noninvasive diagnostic tools for CAD in this specific patient population.
Purpose of the Study:
- To compare the diagnostic accuracy of dobutamine stress cardiac magnetic resonance (DSCMR) with dobutamine stress echocardiography (DSE) in patients with LBBB and suspected CAD.
- To evaluate the incremental value of comprehensive DSCMR, including cine, perfusion, and late gadolinium enhancement (LGE) imaging.
- To assess the potential of DSCMR to reduce the need for invasive coronary angiography.
Main Methods:
- A prospective study involving 82 consecutive patients with LBBB and suspected CAD.
- All patients underwent DSE, DSCMR (cine, first-pass perfusion, LGE), and invasive quantitative coronary angiography within 14 days.
- Diagnostic accuracy metrics were compared between DSE and various components of DSCMR, with a comprehensive DSCMR result defined by LGE or perfusion defects corresponding to wall motion abnormalities.
Main Results:
- Cardiac magnetic resonance (CMR) cine imaging demonstrated higher specificity (87.5% vs. 72.9%), negative predictive value (80.8% vs. 67.3%), and overall diagnostic accuracy (80.4% vs. 72.0%) than DSE, with similar sensitivity (72.0%).
- The addition of first-pass stress perfusion and LGE imaging to CMR cine significantly improved diagnostic performance, achieving 82.4% sensitivity, 95.8% specificity, and 90.2% overall diagnostic accuracy.
- Comprehensive DSCMR showed enhanced diagnostic confidence and improved accuracy metrics over DSE alone.
Conclusions:
- Dobutamine stress cardiac magnetic resonance (DSCMR) is a safe and more accurate diagnostic tool than dobutamine stress echocardiography (DSE) for evaluating suspected coronary artery disease in patients with left bundle branch block.
- A comprehensive DSCMR approach, integrating cine, perfusion, and late gadolinium enhancement, substantially increases diagnostic accuracy, particularly specificity and sensitivity.
- DSCMR serves as a reliable noninvasive alternative to invasive coronary angiography for this patient cohort.
Objectives:
This study aimed to compare dobutamine stress cardiac magnetic resonance (DSCMR) with dobutamine stress echocardiography (DSE) in patients with left bundle branch block (LBBB) and suspected coronary artery disease (CAD).
Background:
Noninvasive diagnosis of CAD in patients with pre-existent LBBB is difficult because single-photon emission computed tomography and stress echocardiography both have limitations. We hypothesized that a comprehensive DSCMR examination including cine, perfusion, and late gadolinium enhancement imaging would be more accurate than DSE, thus potentially reducing the number of unnecessary invasive coronary angiograms.
Methods:
We prospectively evaluated 82 consecutive patients with LBBB referred to our cardiology clinic for investigation of suspected CAD. All 82 patients underwent DSE, DSCMR, and invasive quantitative coronary angiography within 14 days. We compared the diagnostic accuracy of DSE, CMR cine imaging, the additive value of first-pass perfusion, and late gadolinium enhancement. In the comprehensive examination, a positive result was adjudged as the presence of either subendocardial or transmural late gadolinium enhancement with or without inducible peri-infarct ischemia or an inducible perfusion defect corresponding to an inducible regional wall motion abnormality.
Results:
CMR cine imaging (regional wall motion abnormalities) had higher specificity, negative predictive value, and overall diagnostic accuracy than did DSE (87.5% vs. 72.9%; 80.8% vs. 67.3%; and 80.4% vs. 72.0%, respectively), although sensitivity was the same (72.0%). The addition of first-pass stress perfusion and late gadolinium enhancement (scar) further improved diagnostic confidence (sensitivity 82.4%, specificity 95.8%, positive predictive value 93.3%, negative predictive value 88.5%, and diagnostic accuracy 90.2%).
Conclusions:
DSCMR is a safe procedure and has greater diagnostic accuracy than does DSE in assessing patients with suspected CAD and LBBB. A comprehensive examination with the addition of perfusion and late gadolinium enhancement to CMR cine imaging significantly boosted specificity and sensitivity, making DSCMR a reliable alternative to invasive quantitative coronary angiography in this group of patients.
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