Background: We hypothesize that dobutamine-induced stress impacts intracardiac hemodynamic parameters and that this may be linked to decreased exercise capacity in Fontan patients. Therefore, the purpose of this study was to assess the effect of pharmacologic stress on intraventricular kinetic energy (KE), viscous energy loss (EL) and vorticity from four-dimensional (4D) Flow cardiovascular magnetic resonance (CMR) imaging in Fontan patients and to study the association between stress response and exercise capacity.
Methods: Ten Fontan patients underwent whole-heart 4D flow CMR before and during 7.5 μg/kg/min dobutamine infusion and cardiopulmonary exercise testing (CPET) on the same day. Average ventricular KE, EL and vorticity were computed over systole, diastole and the total cardiac cycle (vorticity_vol, KE EL). The relation to maximum oxygen uptake (VO max) from CPET was tested by Pearson's correlation or Spearman's rank correlation in case of non-normality of the data.
Results: Dobutamine stress caused a significant 88 ± 52% increase in KE (KE: 1.8 ± 0.5 vs 3.3 ± 0.9 mJ, P < 0.001), a significant 108 ± 49% increase in EL (EL: 0.9 ± 0.4 vs 1.9 ± 0.9 mW, P < 0.001) and a significant 27 ± 19% increase in vorticity (vorticity_vol: 3441 ± 899 vs 4394 ± 1322 mL/s, P = 0.002). All rest-stress differences (%) were negatively correlated to VO max (KE: r = - 0.83, P = 0.003; EL: r = - 0.80, P = 0.006; vorticity_vol: r = - 0.64, P = 0.047).
Conclusions: 4D flow CMR-derived intraventricular kinetic energy, viscous energy loss and vorticity in Fontan patients increase during pharmacologic stress and show a negative correlation with exercise capacity measured by VO max.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657113 | PMC |
http://dx.doi.org/10.1186/s12968-019-0553-4 | DOI Listing |
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