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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article number157
JournalJournal of Cardiovascular Magnetic Resonance
Volume17
Issue number1
DOIs
StatePublished - Jul 18 2015
Externally publishedYes

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Cardiovascular Physiological Phenomena
Dobutamine
Cardiomyopathies
Magnetic Resonance Spectroscopy
Germany
Pharmacology
Exercise Test
Liver Cirrhosis
Cardiac Output
Canada
Fibrosis
Software

Keywords

  • Cardiomyopathy
  • Dobutamine stress
  • Feature tracking
  • Liver
  • Magnetic resonance
  • Strain

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Assessment of cardiovascular physiology using dobutamine stress cardiovascular magnetic resonance reveals impaired contractile reserve in patients with cirrhotic cardiomyopathy. / Sampaio, Francisco; Lamata, Pablo; Bettencourt, Nuno; Alt, Sophie Charlotte; Ferreira, Nuno; Kowallick, Johannes Tammo; Pimenta, Joana; Kutty, Shelby; Fraga, José; Steinmetz, Michael; Bettencourt, Paulo; Gama, Vasco; Schuster, Andreas.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 17, No. 1, 157, 18.07.2015.

Research output: Contribution to journalArticle

Sampaio, F, Lamata, P, Bettencourt, N, Alt, SC, Ferreira, N, Kowallick, JT, Pimenta, J, Kutty, S, Fraga, J, Steinmetz, M, Bettencourt, P, Gama, V & Schuster, A 2015, 'Assessment of cardiovascular physiology using dobutamine stress cardiovascular magnetic resonance reveals impaired contractile reserve in patients with cirrhotic cardiomyopathy', Journal of Cardiovascular Magnetic Resonance, vol. 17, no. 1, 157. https://doi.org/10.1186/s12968-015-0157-6
Sampaio, Francisco ; Lamata, Pablo ; Bettencourt, Nuno ; Alt, Sophie Charlotte ; Ferreira, Nuno ; Kowallick, Johannes Tammo ; Pimenta, Joana ; Kutty, Shelby ; Fraga, José ; Steinmetz, Michael ; Bettencourt, Paulo ; Gama, Vasco ; Schuster, Andreas. / Assessment of cardiovascular physiology using dobutamine stress cardiovascular magnetic resonance reveals impaired contractile reserve in patients with cirrhotic cardiomyopathy. In: Journal of Cardiovascular Magnetic Resonance. 2015 ; Vol. 17, No. 1.
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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.",
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AU - Sampaio, Francisco

AU - Lamata, Pablo

AU - Bettencourt, Nuno

AU - Alt, Sophie Charlotte

AU - Ferreira, Nuno

AU - Kowallick, Johannes Tammo

AU - Pimenta, Joana

AU - Kutty, Shelby

AU - Fraga, José

AU - Steinmetz, Michael

AU - Bettencourt, Paulo

AU - Gama, Vasco

AU - Schuster, Andreas

PY - 2015/7/18

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N2 - 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.

AB - 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.

KW - Cardiomyopathy

KW - Dobutamine stress

KW - Feature tracking

KW - Liver

KW - Magnetic resonance

KW - Strain

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