TY - JOUR
T1 - Dobutamine stress MRI in repaired tetralogy of Fallot with chronic pulmonary regurgitation
T2 - A comparison with healthy volunteers
AU - Parish, Victoria
AU - Valverde, Israel
AU - Kutty, Shelby
AU - Head, Catherine
AU - Qureshi, Shakeel A.
AU - Sarikouch, Samir
AU - Greil, Gerald
AU - Schaeffter, Tobias
AU - Razavi, Reza
AU - Beerbaum, Philipp
N1 - Funding Information:
Grant support: This work was supported by ‘The Guy's & St Thomas' Charitable Foundation’, London, UK (grant code REF: R041037).
PY - 2013/6/5
Y1 - 2013/6/5
N2 - Background: To compare the ventricular response to dobutamine stress between adult patients with chronic pulmonary regurgitation (PR) after repair of tetralogy of Fallot (r-TOF) and healthy volunteers using a staged dobutamine stress MR (DS-MR) protocol. Methods: Eighteen r-TOF patients (median age 31.9 years, range 16.2-60.1) with severe PR and 10 healthy controls (median age 40.6 years, range 23.9-51.8) completed staged DS-MR (baseline, 10 and 20 μg/kg/min) with ventricular volumetry and pulmonary flow quantification. Comparative analysis involved 3-way ANOVA, t-test, regression analysis, and coefficient of variance. Results: All controls had significant increase of ejection fraction (EF) at each stress level for both ventricles (normal contractile reserve, all p < 0.05). In r-TOF patients (RV-EDV 126 ± 27 ml/m2, RV-EF 55 ± 7%, LV-EF 58 ± 6%, PR-fraction 43 ± 15%), low-dose DS-MR at 10 μg/kg/min demonstrated normal biventricular contractile reserve as seen in volunteers. On increase from 10 to 20 μg/kg/min a subgroup showed worsening ejection fraction (n = 8, p < 0.05), mainly due to lack of reduction or even increase of RV-ESV, while the remainder responded with further reduction of RV-ESV and RV-EDV (n = 10, p < 0.05) and a non-significant trend to increased EF. This different response could not be predicted at baseline. Conclusions: In r-TOF patients with chronic PR, DS-MR at 10 μg/kg/min showed normal biventricular systolic response compared with controls. Increase to 20 μg/kg/min provoked abnormal RV-ESV response in some r-TOF patients, suggesting presence of ventricular systolic dysfunction not evident at rest.
AB - Background: To compare the ventricular response to dobutamine stress between adult patients with chronic pulmonary regurgitation (PR) after repair of tetralogy of Fallot (r-TOF) and healthy volunteers using a staged dobutamine stress MR (DS-MR) protocol. Methods: Eighteen r-TOF patients (median age 31.9 years, range 16.2-60.1) with severe PR and 10 healthy controls (median age 40.6 years, range 23.9-51.8) completed staged DS-MR (baseline, 10 and 20 μg/kg/min) with ventricular volumetry and pulmonary flow quantification. Comparative analysis involved 3-way ANOVA, t-test, regression analysis, and coefficient of variance. Results: All controls had significant increase of ejection fraction (EF) at each stress level for both ventricles (normal contractile reserve, all p < 0.05). In r-TOF patients (RV-EDV 126 ± 27 ml/m2, RV-EF 55 ± 7%, LV-EF 58 ± 6%, PR-fraction 43 ± 15%), low-dose DS-MR at 10 μg/kg/min demonstrated normal biventricular contractile reserve as seen in volunteers. On increase from 10 to 20 μg/kg/min a subgroup showed worsening ejection fraction (n = 8, p < 0.05), mainly due to lack of reduction or even increase of RV-ESV, while the remainder responded with further reduction of RV-ESV and RV-EDV (n = 10, p < 0.05) and a non-significant trend to increased EF. This different response could not be predicted at baseline. Conclusions: In r-TOF patients with chronic PR, DS-MR at 10 μg/kg/min showed normal biventricular systolic response compared with controls. Increase to 20 μg/kg/min provoked abnormal RV-ESV response in some r-TOF patients, suggesting presence of ventricular systolic dysfunction not evident at rest.
KW - Blood flow
KW - Cardiac volume
KW - Magnetic resonance imaging
KW - Pulmonary regurgitation
KW - Stress imaging
KW - Tetralogy of Fallot
KW - Ventricular assessment
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U2 - 10.1016/j.ijcard.2011.10.142
DO - 10.1016/j.ijcard.2011.10.142
M3 - Article
C2 - 22154014
AN - SCOPUS:84877758316
SN - 0167-5273
VL - 166
SP - 96
EP - 105
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 1
ER -