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

AbstractBACKGROUND:
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/m(2), 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.
AuthorsVictoria Parish, Israel Valverde, Shelby Kutty, Catherine Head, Shakeel A Qureshi, Samir Sarikouch, Gerald Greil, Tobias Schaeffter, Reza Razavi, Philipp Beerbaum
JournalInternational journal of cardiology (Int J Cardiol) Vol. 166 Issue 1 Pg. 96-105 (Jun 05 2013) ISSN: 1874-1754 [Electronic] Netherlands
PMID22154014 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCrown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.
Topics
  • Adolescent
  • Adult
  • Chronic Disease
  • Echocardiography, Stress (methods)
  • Exercise Test (methods)
  • Female
  • Humans
  • Magnetic Resonance Imaging (methods)
  • Male
  • Middle Aged
  • Prospective Studies
  • Pulmonary Valve Insufficiency (diagnosis, physiopathology)
  • Tetralogy of Fallot (physiopathology, surgery)
  • Young Adult

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