Year-end Sale % OFF 
Abstract
BackgroundWe 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.MethodsTen 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_volavg cycle, KEavg cycle, ELavg cycle). The relation to maximum oxygen uptake (VO2 max) from CPET was tested by Pearson’s correlation or Spearman’s rank correlation in case of non-normality of the data.ResultsDobutamine stress caused a significant 88 ± 52% increase in KE (KEavg cycle: 1.8 ± 0.5 vs 3.3 ± 0.9 mJ, P < 0.001), a significant 108 ± 49% increase in EL (ELavg cycle: 0.9 ± 0.4 vs 1.9 ± 0.9 mW, P < 0.001) and a significant 27 ± 19% increase in vorticity (vorticity_volavg cycle: 3441 ± 899 vs 4394 ± 1322 mL/s, P = 0.002). All rest-stress differences (%) were negatively correlated to VO2 max (KEavg cycle: r = − 0.83, P = 0.003; ELavg cycle: r = − 0.80, P = 0.006; vorticity_volavg cycle: r = − 0.64, P = 0.047).Conclusions4D 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 VO2 max.
Highlights
We hypothesize that dobutamine-induced stress impacts intracardiac hemodynamic parameters and that this may be linked to decreased exercise capacity in Fontan patients
The purpose of this study was 1) to non-invasively assess the influence of pharmacologic stress on kinetic energy (KE), energy loss (EL) and vorticity measured by 4D flow cardiovascular magnetic resonance (CMR) in intraventricular blood flow in Fontan patients and 2) to study the association between the hemodynamic stress response in terms of KE, EL and vorticity and exercise capacity assessed by maximum oxygen uptake (VO2 max) from cardiopulmonary exercise tests (CPET)
Association between difference heart rate (HR), stroke volume and blood pressure versus KE, EL and vorticity The difference in HR between rest and stress was not associated with the difference in KE, EL or vorticity_vol
Summary
We hypothesize that dobutamine-induced stress impacts intracardiac hemodynamic parameters and that this may be linked to decreased exercise capacity in Fontan patients. 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. Survival of patients after the procedure has increased drastically over the past decades [2, 3], but still, Kamphuis et al Journal of Cardiovascular Magnetic Resonance (2019) 21:43 viscous energy loss (EL, the KE that is lost due to viscosity-induced frictional forces) and vorticity (a measure of the local spinning of blood particles) [13]. Altered intracardiac flow patterns, levels of kinetic energy and vortex formation in the intraventricular blood flow pattern were observed in Fontan patients [16,17,18]. We hypothesize that dobutamine-induced stress would impact these intracardiac hemodynamic parameters and that this may be linked to decreased exercise capacity in Fontan patients
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
