Feasibility of dobutamine stress cardiovascular magnetic resonance imaging in children

Abstract

Purpose:To evaluate the feasibility of dobutamine stress magnetic resonance (DSMR) in pediatric patients. Materials and Methods:The medical records of all DSMR studies performed on patients Յ22 years old at a single institution were retrospectively reviewed. The DSMR protocol included dobutamine doses up to 40 g/kg/minute and atropine to attain the target heart rate [0.85 ⅐ (220 -age)].Results: Thirty-two DSMR studies were performed in 28 patients (median age ϭ 7.3 years; range ϭ 0.8 -22 years). Twenty of the studies were performed under general anesthesia. The protocol was completed in 26 studies, technical problems and interruptions were few, and image quality scores (1-5) for all ventricular wall segments were high (mean ϭ 4.2). A heart rate Ն160 bpm was attained in 84% of the studies, a rate pressure product Ն20,000 beats ⅐ mm Hg in 87%, and a heart rate greater than or equal to the target heart rate in 19%. No serious adverse events occurred. One patient had an inducible wall motion abnormality. Interobserver agreement was 100% (kappa ϭ 1.0) for test positivity and 92% (kappa ϭ 0.72) for wall motion scores. Conclusion:DSMR in pediatric patients is feasible and provides high-quality imaging of all ventricular wall segments with low interobserver variability. Further exploration of DSMR in pediatric patients is warranted, particularly for those children who are unable to cooperate sufficiently for exercise stress or have poor acoustic windows.

Safety and observer variability of cardiac magnetic resonance imaging combined with low-dose dobutamine stress-testing in patients with complex congenital heart disease

“…Major side effects, such as ventricular arrhythmias or even death, have been described in adult patients with coronary artery disease, receiving high doses of dobutamine of up to 40 μg/kg/min [1,2]. Highdose dobutamine stress imaging is rarely used in children and patients with CHD [13,[28][29][30]. It is usually performed to induce wall motion abnormalities in patients with coronary artery abnormalities [4,13].…”

“…Highdose dobutamine stress imaging is rarely used in children and patients with CHD [13,[28][29][30]. It is usually performed to induce wall motion abnormalities in patients with coronary artery abnormalities [4,13]. In both echocardiographic and CMR studies, no major side effects have been reported in pediatric patients using high-dose dobutamine.…”

“…Wall motion analysis is of lesser importance in this patient group with few coronary artery abnormalities. In several small studies abnormal stress responses of ventricular and vascular functions have been reported [8][9][10][11][12][13][14][15][16][17][18]. These abnormal stress responses are of special interest since they are potential surrogate markers related to primary endpoints relevant for the assessment of long-term outcome, such as death or functional impairment.…”

Clinical applications of radionuclide imaging in the evaluation and management of patients with congenital heart disease

“…Many individuals with CHD undergo CMR for surveillance of CHD and ventricular function and stress sequences may be added to these studies. 27 Since prosthetic patches and conduit insertion sites can be identified by CMR, visualizing the anatomy with high spatial resolution can be helpful for interpretation of CMR stress perfusion by demonstrating which regions of the heart are not expected to perfuse. Coronary microvascular dysfunction can be assessed with rest and vasodilator stress gadolinium-enhanced CMR imaging.…”

Myocardial Fibrosis in Congenital Heart Disease

“…This "biphasic response" ence in the pediatric population is more limited, but the available data are encouraging. 11 There are now CMR-compatible ergometers that allow for cardiac functional assessment during exercise. 12 One of the strengths of CMR is its ability to evaluate tissue characteristics.…”