Cardiovascular MR Dobutamine Stress in Adult Tetralogy of Fallot: Disparity Between CMR Volumetry and Flow for Cardiovascular Function

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Abstract

Purpose: To evaluate the MR agreement of cardiac function parameters between volumetric (cine SSFP) and phase contrast flow (PC-flow) assessment in patients with repaired tetralogy of Fallot (r-TOF) and chronic pulmonary regurgitation (PR) at rest and under dobutamine stress (DS-MR). Materials and Methods: We studied 18 patients with r-TOF and severe chronic PR (34 +/- 12.7 years, PR fraction[flow] 44 +/- 15%) by cardiac MR at rest, 10 and 20 mg/kg/min of dobutamine. We compared analogous functional parameters by volumetry and PC-flow: (i) Systemic output [left ventricle stroke volume (LVSV) versus aortic forward flow (AO(FF))], (ii) Pulmonary output [right ventricle stroke volume (RVSV) versus pulmonary forward flow (PA(FF))], (iii) PR volume [(RVSV-LVSV) versus pulmonary backward flow (PA(BF))], (iv) PR fraction [(RVSV-LVSV/RVSV) versus (PA(BF)/PA(FF))]. Results: We found excellent Bland-Altman agreement (mean difference 6 limits of agreement, mL/beat/m(2)) at rest for both the systemic (-0.8 +/- 5.7) and pulmonary strokes volumes (-0.1 +/- 7.6), which slightly deteriorates during DS-MR. The PR volume showed acceptable agreement at rest (-3.6 +/- 15.1), but also further deteriorated during stress (5.4 +/- 24). In contrast, the PR fraction showed poor agreement equally at rest (-5.6 +/- 22.8) and DS-MR (3.2 +/- 19.2). Conclusion: In r-TOF with chronic PR, analogous functional parameters should not be used interchangeably between volumetric and PC-flow assessment during DSMR evaluation.
Original languageEnglish
Pages (from-to)1341 - 1350
Number of pages10
JournalJournal of Magnetic Resonance Imaging
Volume33
Issue number6
DOIs
Publication statusPublished - Jun 2011

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