Disparity between dobutamine stress and physical exercise magnetic resonance imaging in patients with an intra-atrial correction for transposition of the great arteries
Disparity between dobutamine stress and physical exercise magnetic resonance imaging in patients with an intra-atrial correction for transposition of the great arteries
复制标题
DOI：
10.1081/jcmr-200053454
复制
发表时间：
2005-04-01
影响因子：
6.4
通讯作者：
Mulder, BJM
中科院分区：
文献类型：
--
作者：
Oosterhof, T;Tulevski, II;Mulder, BJM
背景。在因大动脉转位（TGA）而进行心房内矫正的患者中，对压力测试的异常反应很常见。然而，当使用不同的压力测试时，血流动力学反应可能会有很大差异。我们将患者和对照组对多巴酚丁胺应激的血流动力学反应与对体育锻炼的反应进行了比较。方法。 39 名患者和 25 名年龄/性别匹配的对照受试者接受了多巴酚丁胺应激（15 毫克/公斤/分钟）或次最大体育锻炼心血管磁共振。测定收缩末期和舒张末期右心室容积（ESV；EDV）。五名代表性患者接受了两项压力测试。对于这些患者，壁增厚储备的计算方法为应激期间的收缩期壁增厚减去休息时的收缩期壁增厚。结果。在对照组中，多巴酚丁胺应激和体育锻炼表现出相似的反应：每搏输出量、心输出量和射血分数显着增加，而 ESV 显着下降，EDV 不变。在患者中，每搏输出量均不会因多巴酚丁胺或运动而增加（分别为 8.6% 和 2.9%）。多巴酚丁胺使射血分数显着增加（16%，p < 0.001），但运动期间射血分数趋于下降（- 2.1%，P = NS）。 EDV 和 ESV 在多巴酚丁胺治疗期间下降，但在运动期间保持不变（分别为 - 22% 与 5.0%，P < 0.001；- 36% 与 9.0%，P < 0.01）。多巴酚丁胺组的壁增厚储备高于运动组（0.9 毫米 vs. -0.6 毫米，P = 0.02）。结论。多巴酚丁胺应激和体育锻炼不能互换用于评估接受心房内 TGA 校正的患者的收缩和舒张功能。这可能会对在临床环境中使用不同的应力 CMR 方法产生影响。
Background. In patients with an intra-atrial correction for transposition of the great arteries (TGA) an abnormal response to stress testing is common. However, hemodynamic responses may vary substantially when different stress tests are used. We compared the hemodynamic response to dobutamine stress with the response to physical exercise in patients and controls. Methods. Thirty-nine patients and 25 age/sex-matched control subjects underwent either dobutamine stress ( 15 mg/kg/min) or submaximal physical exercise cardiovascular magnetic resonance. End-systolic and end-diastolic right ventricular volumes (ESV; EDV) were determined. Five representative patients underwent both stress tests. For these patients, wall thickening reserve was calculated as systolic wall thickening during stress minus systolic wall thickening at rest. Results. In controls, dobutamine stress and physical exercise showed similar responses: stroke volume, cardiac output, and ejection fraction increased significantly, whereas ESV decreased significantly and EDV was unchanged. In patients, stroke volume did not increase with either dobutamine or exercise ( - 8.6% vs. 2.9%). Ejection fraction increased significantly with dobutamine (16%, p < 0.001) but tended to decrease during exercise ( - 2.1%, P = NS). EDV and ESV decreased during dobutamine but were unchanged during exercise ( - 22% vs. 5.0%, P < 0.001; - 36% vs. 9.0%, P < 0.01 respectively). Wall thickening reserve was higher with dobutamine than with exercise (0.9 mm vs. -0.6 mm, P = 0.02). Conclusion. Dobutamine stress and physical exercise cannot be used interchangeably for assessment of systolic and diastolic function in patients with an intra-atrial correction for TGA. This may have consequences for the use of different stress CMR approaches in the clinical setting.