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Changes in blood volume shunting in patients with atrial septal defects : Assessment of heart function with cardiovascular magnetic resonance during dobutamine stress

Stephensen, Sigurdur S. LU ; Steding-Ehrenborg, Katarina LU ; Thilén, Ulf LU ; Holm, Johan LU ; Hochbergs, Peter LU ; Arheden, Hakan LU and Carlsson, Marcus LU (2017) In European Heart Journal Cardiovascular Imaging 18(10). p.1145-1152
Abstract

Background: The purpose of this study was to determine the effect of stress on left-to-right shunting in patients with atrial septal defect (ASD) and to investigate if the degree of shunting, cardiac output (CO), and right ventricular (RV) volumes are related to exercise capacity. Methods: Twenty-six patients with a secundum ASD and 16 healthy volunteers were studied with rest/stress cardiac magnetic resonance using 20 μg/kg/min dobutamine and 0.25-0.75 mg atropine to quantify CO, pulmonary to systemic flow ratio (QP/QS), and left ventricular (LV) and RV volumes. Peak oxygen uptake (VO2 peak) was determined on ergospirometry. Results: In patients with ASD the QP/QS decreased from 2.0 ± 0.2 at rest to 1.5 ± 0.1 (P < 0.001)... (More)

Background: The purpose of this study was to determine the effect of stress on left-to-right shunting in patients with atrial septal defect (ASD) and to investigate if the degree of shunting, cardiac output (CO), and right ventricular (RV) volumes are related to exercise capacity. Methods: Twenty-six patients with a secundum ASD and 16 healthy volunteers were studied with rest/stress cardiac magnetic resonance using 20 μg/kg/min dobutamine and 0.25-0.75 mg atropine to quantify CO, pulmonary to systemic flow ratio (QP/QS), and left ventricular (LV) and RV volumes. Peak oxygen uptake (VO2 peak) was determined on ergospirometry. Results: In patients with ASD the QP/QS decreased from 2.0 ± 0.2 at rest to 1.5 ± 0.1 (P < 0.001) during dobutamine stress (n = 20) and shunt volume per heartbeat decreased from 70 ± 9 to 38 ± 9 mL (P < 0.001). However, absolute shunt volume per minute was unchanged (5.1 ± 0.8 vs. 4.5 ± 1.0 L/min, P = 0.32) explained by a higher increase in systemic CO during stress (90 ± 11%) compared with pulmonary CO (43 ± 7%, P < 0.001). In ASD patients, VO2 peak correlated with aortic CO during stress (r = 0.77) and QP/QS at rest (r = -0.48) but not during stress (P = 0.09). VO2 peak did not correlate with RV volumes in patients. Conclusion: Pulmonary to systemic flow ratio and shunt volume per heartbeat decrease during stress in ASD patients. This may be explained by an enhanced LV diastolic function during stress and may have implications to detect disturbances in LV compliance in ASD patients. A high systemic CO during stress is a strong predictor of exercise capacity.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Heart Journal Cardiovascular Imaging
volume
18
issue
10
pages
1145 - 1152
publisher
Oxford University Press
external identifiers
  • scopus:85041183934
ISSN
2047-2404
DOI
10.1093/ehjci/jew176
language
English
LU publication?
yes
id
01a83818-150d-49e1-8bb9-121ad44383ad
date added to LUP
2018-02-23 12:19:35
date last changed
2019-02-03 05:30:34
@article{01a83818-150d-49e1-8bb9-121ad44383ad,
  abstract     = {<p>Background: The purpose of this study was to determine the effect of stress on left-to-right shunting in patients with atrial septal defect (ASD) and to investigate if the degree of shunting, cardiac output (CO), and right ventricular (RV) volumes are related to exercise capacity. Methods: Twenty-six patients with a secundum ASD and 16 healthy volunteers were studied with rest/stress cardiac magnetic resonance using 20 μg/kg/min dobutamine and 0.25-0.75 mg atropine to quantify CO, pulmonary to systemic flow ratio (QP/QS), and left ventricular (LV) and RV volumes. Peak oxygen uptake (VO<sub>2</sub> peak) was determined on ergospirometry. Results: In patients with ASD the QP/QS decreased from 2.0 ± 0.2 at rest to 1.5 ± 0.1 (P &lt; 0.001) during dobutamine stress (n = 20) and shunt volume per heartbeat decreased from 70 ± 9 to 38 ± 9 mL (P &lt; 0.001). However, absolute shunt volume per minute was unchanged (5.1 ± 0.8 vs. 4.5 ± 1.0 L/min, P = 0.32) explained by a higher increase in systemic CO during stress (90 ± 11%) compared with pulmonary CO (43 ± 7%, P &lt; 0.001). In ASD patients, VO<sub>2</sub> peak correlated with aortic CO during stress (r = 0.77) and QP/QS at rest (r = -0.48) but not during stress (P = 0.09). VO<sub>2</sub> peak did not correlate with RV volumes in patients. Conclusion: Pulmonary to systemic flow ratio and shunt volume per heartbeat decrease during stress in ASD patients. This may be explained by an enhanced LV diastolic function during stress and may have implications to detect disturbances in LV compliance in ASD patients. A high systemic CO during stress is a strong predictor of exercise capacity.</p>},
  author       = {Stephensen, Sigurdur S. and Steding-Ehrenborg, Katarina and Thilén, Ulf and Holm, Johan and Hochbergs, Peter and Arheden, Hakan and Carlsson, Marcus},
  issn         = {2047-2404},
  language     = {eng},
  month        = {10},
  number       = {10},
  pages        = {1145--1152},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal Cardiovascular Imaging},
  title        = {Changes in blood volume shunting in patients with atrial septal defects : Assessment of heart function with cardiovascular magnetic resonance during dobutamine stress},
  url          = {http://dx.doi.org/10.1093/ehjci/jew176},
  volume       = {18},
  year         = {2017},
}