Ventricular response to dobutamine stress cardiac magnetic resonance imaging is associated with adverse outcome during 8-year follow-up in patients with repaired Tetralogy of Fallot
van den Bosch, Eva; Cuypers, Judith A A E; Luijnenburg, S.E.; Duppen, Nienke; Boersma, Eric; Budde, Ricardo; Krestin, Gabriel P.; Blom, Nico A; Breur, Hans MPJ; Snoeren, M.M.; Roos-Hesselink, Jolien W; Kapusta, Livia; Helbing, Willem A.
(2020) European Heart Journal Cardiovascular Imaging, volume 21, issue 9, pp. 1039 - 1046
(Article)
Abstract
Aims The aim of this study was to evaluate the possible value of dobutamine stress cardiac magnetic resonance imaging (CMR) to predict adverse outcome in Tetralogy of Fallot (TOF) patients. Methods In previous prospective multicentre studies, TOF patients underwent low-dose dobutamine stress CMR (7.5 mg/kg/ and results min). Subsequently, during
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regular-care patient follow-up, patients were assessed for reaching the composite endpoint (cardiac death, arrhythmia-related hospitalization, or cardioversion/ablation, VO 2 max <_65% of predicted). A normal stress response was defined as a decrease in end-systolic volume (ESV) and increase in ejection fraction. The relative parameter change during stress was calculated as relative parameter change = [(parameter stress - parameter rest)/parameter rest] * 100. The predictive value of dobutamine stress CMR for the composite endpoint was determined using time-to-event analyses (Kaplan-Meier) and Cox proportional hazard analysis. We studied 100 patients [67 (67%) male, median age at baseline CMR 17.8 years (interquartile range 13.5-34.0), age at TOF repair 0.9 years (0.6-2.1)]. After a median follow-up of 8.6 years (6.7-14.1), 10 patients reached the composite endpoint. An abnormal stress response (30% vs. 4.4%, P = 0.021) was more frequently observed in composite endpoint patients. Also in endpoint patients, the relative decrease in right ventricular ESV decreased less during stress compared with the patients without an endpoint (-17 ± 15 vs. -26 ± 13 %, P = 0.045). Multivariable analyses identified an abnormal stress response (hazard ratio 10.4; 95% confidence interval 2.5-43.7; P = 0.001) as predictor for the composite endpoint. Conclusion An abnormal ventricular response to dobutamine stress is associated with adverse outcome in patients with repaired TOF.
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Keywords: Tetralogy of Fallot, cardiac magnetic resonance imaging, congenital heart disease, dobutamine, outcome, stress imaging, Outcome, Dobutamine, Stress imaging, Congenital heart disease, Cardiac magnetic resonance imaging, Cardiology and Cardiovascular Medicine, Radiology Nuclear Medicine and imaging
ISSN: 2047-2404
Publisher: Oxford University Press
Note: Funding Information: This work was supported by the Dutch Heart Foundation (2013T091, 2008B026, and 2006B095 to E.v.d.B., N.D., and S.E.L.). Publisher Copyright: © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
(Peer reviewed)