King's College London

Research portal

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

Research output: Contribution to journalArticle

Francisco Sampaio, Pablo Lamata de la Orden, Nuno Bettencourt, Sophie Charlotte Alt, Nuno Ferreira, Johannes Tammo Kowallick, Joana Pimenta, Shelby Kutty, José Fraga, Michael Steinmetz, Paulo Bettencourt, Vasco Gama, Andreas Schuster

Original languageEnglish
Article number157
JournalJournal of Cardiovascular Magnetic Resonance
Volume17
Issue number1
DOIs
StatePublished - 18 Jul 2015

Documents

  • s12968_015_0157_6

    s12968_015_0157_6.pdf, 1 MB, application/pdf

    10/12/2015

    Final published version

    CC BY

King's Authors

Abstract

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.

Download statistics

No data available

View graph of relations

© 2018 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454