Technologist Track Session 3: Ischemic Heart Disease (2019)-Dobutamine Stress CMR

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Video Summary

Dobutamine stress CMR uses beta-agonist stimulation to raise heart rate and myocardial oxygen demand, provoking ischemia through supply-demand mismatch. It is used to diagnose coronary artery disease, assess preoperative risk, and evaluate the functional significance of known coronary lesions. Dobutamine is infused in steps up to 40 mcg, with atropine added if the patient does not reach 85% of predicted maximal heart rate. Key contraindications include active ischemia, acute coronary syndrome, significant arrhythmias, and severe hypertension; atropine is contraindicated in narrow-angle glaucoma. The test is generally safe and feasible, with about 90% diagnostic yield, but palpitations and chest pain are common. Interpretation is wall-motion based, with perfusion and late enhancement adding important value. Sensitivity is about 80–85% overall, but drops in concentric LV geometry and hypertrophy; perfusion substantially improves detection. Overall, dobutamine stress CMR is effective, especially when perfusion imaging is added.

Keywords

dobutamine stress CMR

coronary artery disease

ischemia

wall-motion assessment

perfusion imaging

contraindications