Dobutamine stress MRI in repaired tetralogy of Fallot with chronic pulmonary regurgitation: A comparison with healthy volunteers

Victoria Parish, Israel Valverde, Shelby Kutty, Catherine Head, Shakeel A. Qureshi, Samir Sarikouch, Gerald Greil, Tobias Schaeffter, Reza Razavi, Philipp Beerbaum

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)96-105
Number of pages10
JournalInternational Journal of Cardiology
Volume166
Issue number1
DOIs
StatePublished - Jun 5 2013

Fingerprint

Pulmonary Valve Insufficiency
Dobutamine
Tetralogy of Fallot
Healthy Volunteers
Analysis of Variance
Ventricular Dysfunction
Volunteers
Regression Analysis
Lung

Keywords

  • Blood flow
  • Cardiac volume
  • Magnetic resonance imaging
  • Pulmonary regurgitation
  • Stress imaging
  • Tetralogy of Fallot
  • Ventricular assessment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Dobutamine stress MRI in repaired tetralogy of Fallot with chronic pulmonary regurgitation : A comparison with healthy volunteers. / Parish, Victoria; Valverde, Israel; Kutty, Shelby; Head, Catherine; Qureshi, Shakeel A.; Sarikouch, Samir; Greil, Gerald; Schaeffter, Tobias; Razavi, Reza; Beerbaum, Philipp.

In: International Journal of Cardiology, Vol. 166, No. 1, 05.06.2013, p. 96-105.

Research output: Contribution to journalArticle

Parish, V, Valverde, I, Kutty, S, Head, C, Qureshi, SA, Sarikouch, S, Greil, G, Schaeffter, T, Razavi, R & Beerbaum, P 2013, 'Dobutamine stress MRI in repaired tetralogy of Fallot with chronic pulmonary regurgitation: A comparison with healthy volunteers', International Journal of Cardiology, vol. 166, no. 1, pp. 96-105. https://doi.org/10.1016/j.ijcard.2011.10.142
Parish, Victoria ; Valverde, Israel ; Kutty, Shelby ; Head, Catherine ; Qureshi, Shakeel A. ; Sarikouch, Samir ; Greil, Gerald ; Schaeffter, Tobias ; Razavi, Reza ; Beerbaum, Philipp. / Dobutamine stress MRI in repaired tetralogy of Fallot with chronic pulmonary regurgitation : A comparison with healthy volunteers. In: International Journal of Cardiology. 2013 ; Vol. 166, No. 1. pp. 96-105.
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abstract = "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.",
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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

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.

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KW - Cardiac volume

KW - Magnetic resonance imaging

KW - Pulmonary regurgitation

KW - Stress imaging

KW - Tetralogy of Fallot

KW - Ventricular assessment

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