Usefulness of magnetic resonance imaging dobutamine stress in asymptomatic and minimally symptomatic patients with decreased cardiac reserve from congenital heart disease (complete and corrected transposition of the great arteries and subpulmonic obstruction)☆
Section snippets
Methods
Forty-seven asymptomatic and minimally symptomatic patients with chronic RV pressure overload (RV systolic pressure >35 mm/Hg determined by echocardiography) were studied: 24 patients with systemic right ventricles (16 patients with surgically corrected transposition of the great arteries [TGA; Mustard or Senning procedure] and 8 patients with congenitally corrected TGA), 23 patients with pressure overloaded subpulmonic right ventricles, and 11 age- and sex-matched healthy volunteers. The
Results
At baseline, there was no difference in heart rate between the examined groups. Only patients with surgically corrected TGA had RV ejection fractions that were significantly lower than controls (58 ± 10% vs 70 ± 8%, p = 0.02). RV end-diastolic volume was significantly greater in patients with pressure overloaded subpulmonic right ventricles and congenitally corrected TGA than in healthy volunteers (Table 2). During dobutamine stress, heart rate increased significantly in all groups; only
Discussion
To our knowledge this is the first study to investigate cardiac reserve determined by MRI dobutamine stress testing in different asymptomatic and minimally symptomatic patient groups with chronic RV pressure overload (congenitally and surgically corrected TGA, subpulmonic obstruction, and corrected tetralogy of Fallot). Conflicting reports using various techniques and inhomogeneous groups of patients have precluded definite conclusions on the role of various RV function parameters in adult
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Dr. Tulevski was supported by The Netherlands Heart Foundation (NHS), The Hague, and Interuniversity Cardiology Institute (ICIN-KNAW), Utrecht, The Netherlands.