Stress increases intracardiac 4D flow cardiovascular magnetic resonance -derived energetics and vorticity and relates to VO(2)max in Fontan patients

Kamphuis, V.P.; Elbaz, M.S.M.; Boogaard, P.J. van den; Kroft, L.J.M.; Lamb, H.J.; Hazekamp, M.G.; ... ; Westenberg, J.J.M. (2019)

Article / Letter to editor

BackgroundWe hypothesize that dobutamine-induced stress impacts intracardiac hemodynamic parameters and that this may be linked to decreased exercise capacity in Fontan patients. Therefore, the purpose of this study was to assess the effect of pharmacologic stress on intraventricular kinetic energy (KE), viscous energy loss (EL) and vorticity from four-dimensional (4D) Flow cardiovascular magnetic resonance (CMR) imaging in Fontan patients and to study the association between stress response and exercise capacity.MethodsTen Fontan patients underwent whole-heart 4D flow CMR before and during 7.5 mu g/kg/min dobutamine infusion and cardiopulmonary exercise testing (CPET) on the same day. Average ventricular KE, EL and vorticity were computed over systole, diastole and the total cardiac cycle (vorticity_vol(avg cycle), KEavg cycle, ELavg cycle). The relation to maximum oxygen uptake (VO2 max) from CPET was tested by Pearson's correlation or Spearman's rank correlation in case of non-normality of the data.ResultsDobutamine stress caused a significant 8852% increase in KE (KEavg cycle: 1.8 +/- 0.5 vs 3.3 +/- 0.9mJ, P<0.001), a significant 108 +/- 49% increase in EL (ELavg cycle: 0.9 +/- 0.4 vs 1.9 +/- 0.9mW, P<0.001) and a significant 27 +/- 19% increase in vorticity (vorticity_vol(avg cycle): 3441 +/- 899 vs 4394 +/- 1322mL/s, P=0.002). All rest-stress differences (%) were negatively correlated to VO2 max (KEavg cycle: r=-0.83, P=0.003; ELavg cycle: r=-0.80, P=0.006; vorticity_vol(avg cycle): r=-0.64, P=0.047).Conclusions 4D flow CMR-derived intraventricular kinetic energy, viscous energy loss and vorticity in Fontan patients increase during pharmacologic stress and show a negative correlation with exercise capacity measured by VO2 max.

• 4D flow CMR
• Flow
• Kinetic energy: energy loss
• Vorticity
• Fontan

• All authors: Kamphuis, V.P.; Elbaz, M.S.M.; Boogaard, P.J. van den; Kroft, L.J.M.; Lamb, H.J.; Hazekamp, M.G.; Jongbloed, M.R.M.; Blom, N.A.; Helbing, W.A.; Roest, A.A.W.; Westenberg, J.J.M.
• Date: 2019-07-25
• Journal: Journal of Cardiovascular Magnetic Resonance
• Volume: 21
• DOI: doi:10.1186/s12968-019-0553-4