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Stress imaging in congenital cardiac disease

Published online by Cambridge University Press:  23 October 2009

Daniëlle Robbers-Visser
Affiliation:
Department of Paediatrics, Division of Cardiology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, the Netherlands Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
Saskia E. Luijnenburg
Affiliation:
Department of Paediatrics, Division of Cardiology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, the Netherlands Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
Jochem van den Berg
Affiliation:
Department of Paediatrics, Division of Cardiology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, the Netherlands Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
Adriaan Moelker
Affiliation:
Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
Willem A. Helbing*
Affiliation:
Department of Paediatrics, Division of Cardiology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, the Netherlands Department of Radiology, Erasmus MC, Rotterdam, the Netherlands
*
Correspondence to: W.A. Helbing, MD, PhD, Erasmus MC – Sophia Children’s Hospital, Department of Paediatrics, Division of Cardiology, Sp-2429, PO box 2060, 3000 CB Rotterdam, The Netherlands. Tel: +31-10-7036264; Fax: +31-10-7036772; E-mail: w.a.helbing@erasmusmc.nl

Abstract

In patients with coronary arterial disease, stress imaging is able to demonstrate abnormalities in the motion of the ventricular walls, and abnormalities in coronary arterial perfusion not apparent at rest. It can also provide information on prognostic factors. In patients with congenitally malformed hearts, stress imaging is used to determine contractile reserve, abnormalities of mural motion, and global systolic function, but also to assess diastolic and vascular function. In most of these patients, stress is usually induced using pharmacological agents, mainly dobutamine given in varying doses. The clinical usefulness of abnormal responses to the stress induced in such patients has to be addressed in follow-up studies. The abnormal stress might serve as surrogate endpoints, predicting primary endpoints at an early stage, which are useful for stratification of risk in this population of growing patients. We review here the stress imaging studies performed to date in patients with congenitally malformed hearts, with a special emphasis on echocardiography and cardiac magnetic resonance imaging.

Type
Review
Copyright
Copyright © Cambridge University Press 2009

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References

1.Wann, LS, Faris, JV, Childress, RH, Dillon, JC, Weyman, AE, Feigenbaum, H. Exercise cross-sectional echocardiography in ischemic heart disease. Circulation 1979; 60: 13001308.CrossRefGoogle ScholarPubMed
2.Wahl, A, Paetsch, I, Gollesch, A, et al. Safety and feasibility of high-dose dobutamine-atropine stress cardiovascular magnetic resonance for diagnosis of myocardial ischaemia: experience in 1000 consecutive cases. Eur Heart J 2004; 25: 12301236.CrossRefGoogle ScholarPubMed
3.Jahnke, C, Nagel, E, Gebker, R, et al. Prognostic value of cardiac magnetic resonance stress tests: adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation 2007; 115: 17691776.CrossRefGoogle ScholarPubMed
4.Kuijpers, D, Janssen, CH, van Dijkman, PR, Oudkerk, M. Dobutamine stress MRI. Part I. Safety and feasibility of dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia. Eur Radiol 2004; 14: 18231828.CrossRefGoogle ScholarPubMed
5.Wu, WC, Bhavsar, JH, Aziz, GF, Sadaniantz, A. An overview of stress echocardiography in the study of patients with dilated or hypertrophic cardiomyopathy. Echocardiography 2004; 21: 467475.CrossRefGoogle ScholarPubMed
6.Cheng, CP, Herfkens, RJ, Lightner, AL, Taylor, CA, Feinstein, JA. Blood flow conditions in the proximal pulmonary arteries and vena cavae: healthy children during upright cycling exercise. Am J Physiol Heart Circ Physiol 2004; 287: H921H926.CrossRefGoogle ScholarPubMed
7.Alpert, BS, Bloom, KR, Olley, PM. Assessment of left ventricular contractility during supine exercise in children with left-sided cardiac disease. Br Heart J 1980; 44: 703710.CrossRefGoogle ScholarPubMed
8.Roest, AA, Kunz, P, Helbing, WA, et al. Prolonged cardiac recovery from exercise in asymptomatic adults late after atrial correction of transposition of the great arteries: evaluation with magnetic resonance flow mapping. Am J Cardiol 2001; 88: 10111017.CrossRefGoogle ScholarPubMed
9.Roest, AA, Helbing, WA, Kunz, P, et al. Exercise MR imaging in the assessment of pulmonary regurgitation and biventricular function in patients after tetralogy of fallot repair. Radiology 2002; 223: 204211.CrossRefGoogle ScholarPubMed
10.Hauser, M, Bengel, FM, Kuhn, A, et al. Myocardial blood flow and flow reserve after coronary reimplantation in patients after arterial switch and ross operation. Circulation 2001; 103: 18751880.CrossRefGoogle ScholarPubMed
11.Kaplan, JD, Foster, E, Redberg, RF, Schiller, NB. Exercise Doppler echocardiography identifies abnormal hemodynamics in adults with congenital heart disease. Am Heart J 1994; 127: 15721580.CrossRefGoogle ScholarPubMed
12.Cyran, SE, Grzeszczak, M, Kaufman, K, et al. Aortic “recoarctation” at rest versus at exercise in children as evaluated by stress Doppler echocardiography after a “good” operative result. Am J Cardiol 1993; 71: 963970.CrossRefGoogle ScholarPubMed
13.Oyen, EM, Ingerfeld, G, Ignatzy, K, Brode, PE. Dynamic exercise echocardiography in children with congenital heart disease affecting the left heart. Int J Cardiol 1987; 17: 315325.CrossRefGoogle ScholarPubMed
14.Hjortdal, VE, Christensen, TD, Larsen, SH, Emmertsen, K, Pedersen, EM. Caval blood flow during supine exercise in normal and Fontan patients. Ann Thorac Surg 2008; 85: 599603.CrossRefGoogle ScholarPubMed
15.Hjortdal, VE, Emmertsen, K, Stenbog, E, et al. Effects of exercise and respiration on blood flow in total cavopulmonary connection: a real-time magnetic resonance flow study. Circulation 2003; 108: 12271231.CrossRefGoogle ScholarPubMed
16.Pedersen, EM, Stenbog, EV, Frund, T, et al. Flow during exercise in the total cavopulmonary connection measured by magnetic resonance velocity mapping. Heart 2002; 87: 554558.CrossRefGoogle ScholarPubMed
17.Pedersen, EM, Kozerke, S, Ringgaard, S, Scheidegger, MB, Boesiger, P. Quantitative abdominal aortic flow measurements at controlled levels of ergometer exercise. Magn Reson Imaging 1999; 17: 489494.CrossRefGoogle ScholarPubMed
18.Roest, AA, Kunz, P, Lamb, HJ, Helbing, WA, van der Wall, EE, de Roos, A. Biventricular response to supine physical exercise in young adults assessed with ultrafast magnetic resonance imaging. Am J Cardiol 2001; 87: 601605.CrossRefGoogle ScholarPubMed
19.Berthe, C, Pierard, LA, Hiernaux, M, et al. Predicting the extent and location of coronary artery disease in acute myocardial infarction by echocardiography during dobutamine infusion. Am J Cardiol 1986; 58: 11671172.CrossRefGoogle ScholarPubMed
20.Picano, E, Lattanzi, F, Masini, M, Distante, A, L’Abbate, A. High dose dipyridamole echocardiography test in effort angina pectoris. J Am Coll Cardiol 1986; 8: 848854.CrossRefGoogle ScholarPubMed
21.Berg, RA, Padbury, JF, Donnerstein, RL, Klewer, SE, Hutter, JJ Jr. Dobutamine pharmacokinetics and pharmacodynamics in normal children and adolescents. J Pharmacol Exp Ther 1993; 265: 12321238.Google ScholarPubMed
22.Michelfelder, EC, Witt, SA, Khoury, P, Kimball, TR. Moderate-dose dobutamine maximizes left ventricular contractile response during dobutamine stress echocardiography in children. J Am Soc Echocardiogr 2003; 16: 140146.CrossRefGoogle ScholarPubMed
23.Harada, K, Tamura, M, Ito, T, Suzuki, T, Takada, G. Effects of low-dose dobutamine on left ventricular diastolic filling in children. Pediatr Cardiol 1996; 17: 220225.CrossRefGoogle ScholarPubMed
24.De Wolf, D, Suys, B, Verhaaren, H, Matthys, D, Taeymans, Y. Low-dose dobutamine stress echocardiography in children and young adults. Am J Cardiol 1998; 81: 895901.CrossRefGoogle ScholarPubMed
25.Noto, N, Ayusawa, M, Karasawa, K, et al. Dobutamine stress echocardiography for detection of coronary artery stenosis in children with Kawasaki disease. J Am Coll Cardiol 1996; 27: 12511256.CrossRefGoogle ScholarPubMed
26.Taylor, AM, Dymarkowski, S, De Meerleer, K, et al. Validation and application of single breath-hold cine cardiac MR for ventricular function assessment in children with congenital heart disease at rest and during adenosine stress. J Cardiovasc Magn Reson 2005; 7: 743751.CrossRefGoogle ScholarPubMed
27.Li, W, Hornung, TS, Francis, DP, et al. Relation of biventricular function quantified by stress echocardiography to cardiopulmonary exercise capacity in adults with Mustard (atrial switch) procedure for transposition of the great arteries. Circulation 2004; 110: 13801386.CrossRefGoogle ScholarPubMed
28.Apostolopoulou, SC, Laskari, CV, Tsoutsinos, A, Rammos, S. Doppler tissue imaging evaluation of right ventricular function at rest and during dobutamine infusion in patients after repair of tetralogy of Fallot. Int J Cardiovasc Imaging 2007; 23: 2531.CrossRefGoogle ScholarPubMed
29.Brili, SV, Alexopoulos, NA, Barberis, VI, et al. Dobutamine stress echocardiography for the evaluation of cardiac reserve late after Fontan operation. Hellenic J Cardiol 2007; 48: 252257.Google ScholarPubMed
30.Strigl, S, Beroukhim, R, Valente, AM, et al. Feasibility of dobutamine stress cardiovascular magnetic resonance imaging in children. J Magn Reson Imaging 2009; 29: 313319.CrossRefGoogle ScholarPubMed
31.van den Berg, J, Strengers, JL, Wielopolski, PA, et al. Assessment of biventricular functional reserve and NT-proBNP levels in patients with RV volume overload after repair of tetralogy of Fallot at young age. Int J Cardiol 2008; doi:10.1016/j.ijcard.2008.01.011.CrossRefGoogle ScholarPubMed
32.van den Berg, J, Wielopolski, PA, Meijboom, FJ, et al. Diastolic function in repaired tetralogy of Fallot at rest and during stress: assessment with MR imaging. Radiology 2007; 243: 212219.CrossRefGoogle ScholarPubMed
33.Robbers-Visser, D, Helderman, F, Strengers, JL, et al. Pulmonary artery size and function after Fontan operation at a young age. J Magn Reson Imaging 2008; 28: 11011107.CrossRefGoogle ScholarPubMed
34.Robbers-Visser, D, Ten Harkel, DJ, Kapusta, L, et al. Usefulness of cardiac magnetic resonance imaging combined with low-dose dobutamine stress to detect an abnormal ventricular stress response in children and young adults after fontan operation at young age. Am J Cardiol 2008; 101: 16571662.CrossRefGoogle Scholar
35.Hui, L, Chau, AK, Leung, MP, Chiu, CS, Cheung, YF. Assessment of left ventricular function long term after arterial switch operation for transposition of the great arteries by dobutamine stress echocardiography. Heart 2005; 91: 6872.CrossRefGoogle ScholarPubMed
36.Brili, S, Stamatopoulos, I, Barbetseas, J, et al. Usefulness of dobutamine stress echocardiography with Tissue Doppler imaging for the evaluation and follow-up of patients with repaired tetralogy of Fallot. J Am Soc Echocardiogr 2008; 21: 10931098.CrossRefGoogle ScholarPubMed
37.Fratz, S, Hager, A, Busch, R, et al. Patients after atrial switch operation for transposition of the great arteries can not increase stroke volume under dobutamine stress as opposed to patients with congenitally corrected transposition. Circ J 2008; 72: 11301135.CrossRefGoogle Scholar
38.Tulevski, I, van der Wall, EE, Groenink, M, et al. Usefulness of magnetic resonance imaging dobutamine stress in asymptomatic and minimally symptomatic patients with decreased cardiac reserve from congenital heart disease (complete and corrected transposition of the great arteries and subpulmonic obstruction). Am J Cardiol 2002; 89: 10771081.CrossRefGoogle ScholarPubMed
39.Vesely, MR, Dilsizian, V. Nuclear cardiac stress testing in the era of molecular medicine. J Nucl Med 2008; 49: 399413.CrossRefGoogle ScholarPubMed
40.Fukuda, T, Ishibashi, M, Shinohara, T, Miyake, T, Kudoh, T, Saga, T. Follow-up assessment of the collateral circulation in patients with Kawasaki disease who underwent dipyridamole stress technetium-99m tetrofosmin scintigraphy. Pediatr Cardiol 2005; 26: 558564.CrossRefGoogle ScholarPubMed
41.Hauser, M, Bengel, F, Kuehn, A, et al. Myocardial blood flow and coronary flow reserve in children with “normal” epicardial coronary arteries after the onset of Kawasaki disease assessed by positron emission tomography. Pediatr Cardiol 2004; 25: 108112.Google ScholarPubMed
42.Bengel, FM, Hauser, M, Duvernoy, CS, et al. Myocardial blood flow and coronary flow reserve late after anatomical correction of transposition of the great arteries. J Am Coll Cardiol 1998; 32: 19551961.CrossRefGoogle ScholarPubMed
43.Karasawa, K, Miyashita, M, Taniguchi, K, et al. Detection of myocardial contractile reserve by low-dose dobutamine quantitative gated single-photon emission computed tomography in patients with Kawasaki disease and severe coronary artery lesions. Am J Cardiol 2003; 92: 865868.CrossRefGoogle ScholarPubMed
44.Donnelly, JP, Raffel, DM, Shulkin, BL, et al. Resting coronary flow and coronary flow reserve in human infants after repair or palliation of congenital heart defects as measured by positron emission tomography. J Thorac Cardiovasc Surg 1998; 115: 103110.CrossRefGoogle ScholarPubMed
45.Hauser, M, Bengel, FM, Kuhn, A, et al. Myocardial perfusion and coronary flow reserve assessed by positron emission tomography in patients after Fontan-like operations. Pediatr Cardiol 2003; 24: 386392.CrossRefGoogle ScholarPubMed
46.Helbing, WA, Bosch, HG, Maliepaard, C, et al. Comparison of echocardiographic methods with magnetic resonance imaging for assessment of right ventricular function in children. Am J Cardiol 1995; 76: 589594.CrossRefGoogle ScholarPubMed
47.Hirsch, R, Kilner, PJ, Connelly, MS, Redington, AN, St John Sutton, MG, Somerville, J. Diagnosis in adolescents and adults with congenital heart disease. Prospective assessment of individual and combined roles of magnetic resonance imaging and transesophageal echocardiography. Circulation 1994; 90: 29372951.CrossRefGoogle ScholarPubMed
48.Pennell, DJ, Underwood, SR, Manzara, CC, et al. Magnetic resonance imaging during dobutamine stress in coronary artery disease. Am J Cardiol 1992; 70: 3440.CrossRefGoogle ScholarPubMed
49.Paetsch, I, Jahnke, C, Wahl, A, et al. Comparison of dobutamine stress magnetic resonance, adenosine stress magnetic resonance, and adenosine stress magnetic resonance perfusion. Circulation 2004; 110: 835842.CrossRefGoogle ScholarPubMed
50.Tulevski, II, Lee, PL, Groenink, M, et al. Dobutamine-induced increase of right ventricular contractility without increased stroke volume in adolescent patients with transposition of the great arteries: evaluation with magnetic resonance imaging. Int J Card Imaging 2000; 16: 471478.CrossRefGoogle ScholarPubMed
51.Oosterhof, T, Tulevski, II, Roest, AA, et al. Disparity between dobutamine stress and physical exercise magnetic resonance imaging in patients with an intra-atrial correction for transposition of the great arteries. J Cardiovasc Magn Reson 2005; 7: 383389.CrossRefGoogle ScholarPubMed
52.Dodge-Khatami, A, Tulevski, II, Bennink, GB, et al. Comparable systemic ventricular function in healthy adults and patients with unoperated congenitally corrected transposition using MRI dobutamine stress testing. Ann Thorac Surg 2002; 73: 17591764.CrossRefGoogle ScholarPubMed
53.van der Zedde, J, Oosterhof, T, Tulevski, II, Vliegen, HW, Mulder, BJ. Comparison of segmental and global systemic ventricular function at rest and during dobutamine stress between patients with transposition and congenitally corrected transposition. Cardiol Young 2005; 15: 148153.CrossRefGoogle ScholarPubMed
54.Tulevski, II, Hirsch, A, Dodge-Khatami, A, Stoker, J, van der Wall, EE, Mulder, BJ. Effect of pulmonary valve regurgitation on right ventricular function in patients with chronic right ventricular pressure overload. Am J Cardiol 2003; 92: 113116.CrossRefGoogle ScholarPubMed
55.Lanzarini, L, Bossi, G, Laudisa, ML, Klersy, C, Arico, M. Lack of clinically significant cardiac dysfunction during intermediate dobutamine doses in long-term childhood cancer survivors exposed to anthracyclines. Am Heart J 2000; 140: 315323.CrossRefGoogle ScholarPubMed
56.Hui, L, Leung, MP, Ha, SY, Chau, AKT, Cheung, YF. Early detection of left ventricular dysfunction in patients with {beta} thalassaemia major by dobutamine stress echocardiography. Heart 2003; 89: 669670.CrossRefGoogle ScholarPubMed
57.Donofrio, MT, Kakavand, B, Moskowitz, WB. Evaluation of regional wall motion and quantitative measures of ventricular function during dobutamine stress echocardiography in pediatric cardiac transplantation patients. J Am Soc Echocardiogr 2000; 13: 932940.CrossRefGoogle ScholarPubMed
58.Larsen, RL, Applegate, PM, Dyar, DA, et al. Dobutamine stress echocardiography for assessing coronary artery disease after transplantation in children. J Am Coll Cardiol 1998; 32: 515520.CrossRefGoogle ScholarPubMed
59.Valsangiacomo Buechel, ER, Dave, HH, Kellenberger, CJ, et al. Remodelling of the right ventricle after early pulmonary valve replacement in children with repaired tetralogy of Fallot: assessment by cardiovascular magnetic resonance. Eur Heart J 2005; 26: 27212727.CrossRefGoogle Scholar
60.Coma-Canella, I, Garcia Velloso, MJ, Maceira, A, et al. [Isotopic ventriculography in healthy young volunteers. Their response to different types of stress]. Rev Esp Cardiol 1997; 50: 709714.CrossRefGoogle ScholarPubMed
61.Kimball, TR, Mays, WA, Khoury, PR, Mallie, R, Claytor, RP. Echocardiographic determination of left ventricular preload, afterload, and contractility during and after exercise. J Pediatr 1993; 122: S89S94.CrossRefGoogle ScholarPubMed
62.Mahony, L, Sleeper, LA, Anderson, PA, et al. The Pediatric Heart Network: a primer for the conduct of multicenter studies in children with congenital and acquired heart disease. Pediatr Cardiol 2006; 27: 191198.CrossRefGoogle ScholarPubMed
63.Derrick, GP, Narang, I, White, PA, et al. Failure of stroke volume augmentation during exercise and dobutamine stress is unrelated to load-independent indexes of right ventricular performance after the Mustard operation. Circulation 2000; 102: III154III159.CrossRefGoogle ScholarPubMed
64.Kuehne, T, Yilmaz, S, Steendijk, P, et al. Magnetic resonance imaging analysis of right ventricular pressure-volume loops: in vivo validation and clinical application in patients with pulmonary hypertension. Circulation 2004; 110: 20102016.CrossRefGoogle ScholarPubMed
65.Fogel, MA. Assessment of cardiac function by magnetic resonance imaging. Pediatr Cardiol 2000; 21: 5969.CrossRefGoogle ScholarPubMed
66.Bree, D, Wollmuth, JR, Cupps, BP, et al. Low-dose dobutamine tissue-tagged magnetic resonance imaging with 3-dimensional strain analysis allows assessment of myocardial viability in patients with ischemic cardiomyopathy. Circulation 2006; 114: I33I36.CrossRefGoogle ScholarPubMed