Feasibility of dobutamine stress cardiovascular magnetic resonance imaging in children

Abstract

To evaluate the feasibility of dobutamine stress magnetic resonance (DSMR) in pediatric patients. The medical records of all DSMR studies performed on patients < or =22 years old at a single institution were retrospectively reviewed. The DSMR protocol included dobutamine doses up to 40 microg/kg/minute and atropine to attain the target heart rate [0.85 . (220 - age)]. Thirty-two DSMR studies were performed in 28 patients (median age = 7.3 years; range = 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 = 4.2). A heart rate > or =160 bpm was attained in 84% of the studies, a rate pressure product > or =20,000 beats . 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 = 1.0) for test positivity and 92% (kappa = 0.72) for wall motion scores. 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.