Protocol
  1. Anatomy module (A)
  2. LV function module (B), 3 SA, 2-3 LA views
  3. Dobutamine Stress module (B)
    • 3min-intervals: 10/20/30/40 mcg/kg/min
    • HR target = 0.85 x (220-age)
    • Consider 0.5 mg atropine x 2 to increase HR
    • Repeat cine images at each stress level
  4. LGE module (E)
Report
  1. Dimensions (corrected for BSA) and function
    • LV: EDV, ESV, SV, EF / RV: EDV, ESV, SV, EF
    • Regional wall motion abnormalities (17 segments)
      • Improvement during low-dose stress (=viability)
      • Improvement or biphasic response during high- dose stress (=ischemia)
  2. Presence and transmural extent of scar
  3. Summarize: resting function, contractile reserve, wall motion index, ischemia for coronary territories
  4. Comment if any valvular regurgitation worsens
Key Issues
  1. Check BP at each stage of protocol / monitor ECG
  2. Always view cine loops during stress online
  3. Stop test if any of the following occurs:
    • New wall motion abnormalities
    • Serious side effects
    • Achievement of peak HR
    • Contraindications for dobutamine: narrow-angle glaucoma, myasthenia gravis, obstructive uropathy, obstructive gastrointestinal disorders
Tips and Tricks
  1. Use “3 out of 5” technique (perfusion module) to position SA slices