Assessment of cardiovascular physiology using dobutamine stress cardiovascular magnetic resonance reveals impaired contractile reserve in patients with cirrhotic cardiomyopathy

TY - JOUR

T1 - Assessment of cardiovascular physiology using dobutamine stress cardiovascular magnetic resonance reveals impaired contractile reserve in patients with cirrhotic cardiomyopathy

AU - Sampaio, Francisco

AU - Lamata de la Orden, Pablo

AU - Bettencourt, Nuno

AU - Alt, Sophie Charlotte

AU - Ferreira, Nuno

AU - Kowallick, Johannes Tammo

AU - Pimenta, Joana

AU - Kutty, Shelby

AU - Fraga, José

AU - Steinmetz, Michael

AU - Bettencourt, Paulo

AU - Gama, Vasco

AU - Schuster, Andreas

PY - 2015/7/18

Y1 - 2015/7/18

N2 - Background: Liver cirrhosis has been shown to affect cardiac performance. However cardiac dysfunction may only be revealed under stress conditions. The value of non-invasive stress tests in diagnosing cirrhotic cardiomyopathy is unclear. We sought to investigate the response to pharmacological stimulation with dobutamine in patients with cirrhosis using cardiovascular magnetic resonance. Methods: Thirty-six patients and eight controls were scanned using a 1.5 T scanner (Siemens Symphony TIM; Siemens, Erlangen, Germany). Conventional volumetric and feature tracking analysis using dedicated software (CMR42; Circle Cardiovascular Imaging Inc, Calgary, Canada and Diogenes MRI; Tomtec; Germany, respectively) were performed at rest and during low to intermediate dose dobutamine stress. Results: Whilst volumetry based parameters were similar between patients and controls at rest, patients had a smaller increase in cardiac output during stress (p=0.015). Ejection fraction increase was impaired in patients during 10 μg/kg/min dobutamine as compared to controls (6.9 % vs. 16.5 %, p=0.007), but not with 20 μg/kg/min (12.1 % vs. 17.6 %, p=0.12). This was paralleled by an impaired improvement in circumferential strain with low dose (median increase of 14.4 % vs. 30.9 %, p=0.03), but not with intermediate dose dobutamine (median increase of 29.4 % vs. 33.9 %, p=0.54). There was an impaired longitudinal strain increase in patients as compared to controls during low (median increase of 6.6 % vs 28.6 %, p<0.001) and intermediate dose dobutamine (median increase of 2.6%vs, 12.6 % p=0.016). Radial strain response to dobutamine was similar in patients and controls (p>0.05). Conclusion: Cirrhotic cardiomyopathy is characterized by an impaired cardiac pharmacological response that can be detected with magnetic resonance myocardial stress testing. Deformation analysis parameters may be more sensitive in identifying abnormalities in inotropic response to stress than conventional methods.

AB - Background: Liver cirrhosis has been shown to affect cardiac performance. However cardiac dysfunction may only be revealed under stress conditions. The value of non-invasive stress tests in diagnosing cirrhotic cardiomyopathy is unclear. We sought to investigate the response to pharmacological stimulation with dobutamine in patients with cirrhosis using cardiovascular magnetic resonance. Methods: Thirty-six patients and eight controls were scanned using a 1.5 T scanner (Siemens Symphony TIM; Siemens, Erlangen, Germany). Conventional volumetric and feature tracking analysis using dedicated software (CMR42; Circle Cardiovascular Imaging Inc, Calgary, Canada and Diogenes MRI; Tomtec; Germany, respectively) were performed at rest and during low to intermediate dose dobutamine stress. Results: Whilst volumetry based parameters were similar between patients and controls at rest, patients had a smaller increase in cardiac output during stress (p=0.015). Ejection fraction increase was impaired in patients during 10 μg/kg/min dobutamine as compared to controls (6.9 % vs. 16.5 %, p=0.007), but not with 20 μg/kg/min (12.1 % vs. 17.6 %, p=0.12). This was paralleled by an impaired improvement in circumferential strain with low dose (median increase of 14.4 % vs. 30.9 %, p=0.03), but not with intermediate dose dobutamine (median increase of 29.4 % vs. 33.9 %, p=0.54). There was an impaired longitudinal strain increase in patients as compared to controls during low (median increase of 6.6 % vs 28.6 %, p<0.001) and intermediate dose dobutamine (median increase of 2.6%vs, 12.6 % p=0.016). Radial strain response to dobutamine was similar in patients and controls (p>0.05). Conclusion: Cirrhotic cardiomyopathy is characterized by an impaired cardiac pharmacological response that can be detected with magnetic resonance myocardial stress testing. Deformation analysis parameters may be more sensitive in identifying abnormalities in inotropic response to stress than conventional methods.

KW - Cardiomyopathy

KW - Dobutamine stress

KW - Feature tracking

KW - Liver

KW - Magnetic resonance

KW - Strain

UR - http://www.scopus.com/inward/record.url?scp=84937572424&partnerID=8YFLogxK

U2 - 10.1186/s12968-015-0157-6

DO - 10.1186/s12968-015-0157-6

M3 - Article

SN - 1097-6647

VL - 17

JO - Journal of Cardiovascular Magnetic Resonance

JF - Journal of Cardiovascular Magnetic Resonance

IS - 1

M1 - 157

ER -