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

作者：Parish Victoria^*; Valverde Israel; Kutty Shelby; Head Catherine; Qureshi Shakeel A; Sarikouch Samir; Greil Gerald; Schaeffter Tobias; Razavi Reza; Beerbaum Philipp

来源：International Journal of Cardiology, 2013, 166(1): 96-105.

DOI：10.1016/j.ijcard.2011.10.142

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

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. %26lt;br%26gt;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 mu g/kg/min) with ventricular volumetry and pulmonary flow quantification. Comparative analysis involved 3-way ANOVA, t-test, regression analysis, and coefficient of variance. %26lt;br%26gt;Results: All controls had significant increase of ejection fraction (EF) at each stress level for both ventricles (normal contractile reserve, all p %26lt; 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 mu g/kg/min demonstrated normal biventricular contractile reserve as seen in volunteers. On increase from 10 to 20 mu g/kg/min a subgroup showed worsening ejection fraction (n = 8, p %26lt; 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 %26lt; 0.05) and a non-significant trend to increased EF. This different response could not be predicted at baseline. %26lt;br%26gt;Conclusions: In r-TOF patients with chronic PR, DS-MR at 10 mu g/kg/min showed normal biventricular systolic response compared with controls. Increase to 20 mu g/kg/min provoked abnormal RV-ESV response in some r-TOF patients, suggesting presence of ventricular systolic dysfunction not evident at rest.

• 出版日期2013-6-5