Dobutamine stress testing for the  evaluation of atrial and diastolic  ventricular function in Fontan patients

Jelle van der Ven; Sjoerd Bossers; Eva van den Bosch; Niels Dam; Irene M. Kuipers; Gabrielle G. van Iperen; Lucia J M Kroft; L Kapusta; ADJ (Arend) ten Harkel; W.A. Helbing

doi:10.1136/openhrt-2020-001487

Dobutamine stress testing for the evaluation of atrial and diastolic ventricular function in Fontan patients

Jelle van der Ven, Sjoerd Bossers, Eva van den Bosch, Niels Dam, Irene M. Kuipers, Gabrielle G. van Iperen, Lucia J M Kroft, L Kapusta, ADJ (Arend) ten Harkel, W.A. Helbing

Pediatrics

Research output: Contribution to journal › Article › Academic › peer-review

4 Citations (Scopus)

20 Downloads (Pure)

Abstract

Objective To assess the atrial and ventricular diastolic function response to dobutamine stress in Fontan patients, and to relate these measurements to exercise capacity and events during the follow-up. Methods We performed a secondary analysis of a cross-sectional multicentre study of Fontan patients with intra-atrial lateral tunnel (ILT) or extracardiac conduit (ECC) modification. Subjects underwent cardiac MRI during rest and low-dose dobutamine stress, and cardiopulmonary exercise testing. Atrial and diastolic ventricular function parameters were derived from volume-time curves. Medical records were abstracted for a composite end-point of death, listing for transplant, arrhythmia and reintervention. Spearman's r correlation tests and Cox proportional hazards models were used to assess the relation between the dobutamine response for atrial and diastolic ventricular function and outcomes, including exercise capacity. Results We included 57 patients (26 ECC; 31 ILT) aged 12.8 (IQR (10.3-15.5)) years. During dobutamine stress atrial cyclic volume change increased (3.0 (0.4-5.9) mL/m 2, p<0.001), as did early (1.9 (-1.6 to 3.6) mL/m 2, p=0.001) and late emptying volume (2.2 (0.2-4.4) mL/m 2, p<0.001). Ventricular early filling decreased (-1.6 (-5.7 to 0.7) mL/m 2,p=0.046) and ventricular late filling increased (1.0 (-0.4 to 3.4) mL/m 2,p<0.001) while stroke volume remained similar. Only for patients with the ECC modification, atrial early emptying volume increase correlated with peak oxygen uptake (ρ=0.66,p=0.002). No other parameter related to exercise capacity. During a median 7.1-year follow-up, 22 patients reached the composite endpoint. No parameter predicted events during the follow-up. Conclusions Dobutamine stress augmented atrial reservoir and pump function for Fontan patients. Atrial early emptying reserve related to exercise capacity in ECC patients. No other atrial or diastolic ventricular function parameter related to outcomes.

Original language	English
Article number	e001487
Number of pages	8
Journal	Congenital Heart Disease
Volume	8
Issue number	1
DOIs	https://doi.org/10.1136/openhrt-2020-001487
Publication status	Published - 12 Mar 2021

Bibliographical note

Funding Information:
Funding JPGvdv, EvdB (grant 2013T091) and SSMB (grant 2008T037) are supported by a research grant from the Dutch Heart Foundation.

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Access to Document

10.1136/openhrt-2020-001487Licence: CC BY

openhrt_2020_001487.pdfFinal published version, 323 KBLicence: CC BY

Cite this

van der Ven, J., Bossers, S., van den Bosch, E., Dam, N., Kuipers, I. M., van Iperen, G. G., Kroft, L. J. M., Kapusta, L., ten Harkel, ADJ., & Helbing, W. A. (2021). Dobutamine stress testing for the evaluation of atrial and diastolic ventricular function in Fontan patients. Congenital Heart Disease, 8(1), Article e001487. https://doi.org/10.1136/openhrt-2020-001487

@article{6869514bee1e400b8de94f26375f71fb,

title = "Dobutamine stress testing for the evaluation of atrial and diastolic ventricular function in Fontan patients",

abstract = "Objective To assess the atrial and ventricular diastolic function response to dobutamine stress in Fontan patients, and to relate these measurements to exercise capacity and events during the follow-up. Methods We performed a secondary analysis of a cross-sectional multicentre study of Fontan patients with intra-atrial lateral tunnel (ILT) or extracardiac conduit (ECC) modification. Subjects underwent cardiac MRI during rest and low-dose dobutamine stress, and cardiopulmonary exercise testing. Atrial and diastolic ventricular function parameters were derived from volume-time curves. Medical records were abstracted for a composite end-point of death, listing for transplant, arrhythmia and reintervention. Spearman's r correlation tests and Cox proportional hazards models were used to assess the relation between the dobutamine response for atrial and diastolic ventricular function and outcomes, including exercise capacity. Results We included 57 patients (26 ECC; 31 ILT) aged 12.8 (IQR (10.3-15.5)) years. During dobutamine stress atrial cyclic volume change increased (3.0 (0.4-5.9) mL/m 2, p<0.001), as did early (1.9 (-1.6 to 3.6) mL/m 2, p=0.001) and late emptying volume (2.2 (0.2-4.4) mL/m 2, p<0.001). Ventricular early filling decreased (-1.6 (-5.7 to 0.7) mL/m 2,p=0.046) and ventricular late filling increased (1.0 (-0.4 to 3.4) mL/m 2,p<0.001) while stroke volume remained similar. Only for patients with the ECC modification, atrial early emptying volume increase correlated with peak oxygen uptake (ρ=0.66,p=0.002). No other parameter related to exercise capacity. During a median 7.1-year follow-up, 22 patients reached the composite endpoint. No parameter predicted events during the follow-up. Conclusions Dobutamine stress augmented atrial reservoir and pump function for Fontan patients. Atrial early emptying reserve related to exercise capacity in ECC patients. No other atrial or diastolic ventricular function parameter related to outcomes.",

author = "{van der Ven}, Jelle and Sjoerd Bossers and {van den Bosch}, Eva and Niels Dam and Kuipers, {Irene M.} and {van Iperen}, {Gabrielle G.} and Kroft, {Lucia J M} and L Kapusta and {ten Harkel}, {ADJ (Arend)} and W.A. Helbing",

note = "Funding Information: Funding JPGvdv, EvdB (grant 2013T091) and SSMB (grant 2008T037) are supported by a research grant from the Dutch Heart Foundation. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2021",

month = mar,

day = "12",

doi = "10.1136/openhrt-2020-001487",

language = "English",

volume = "8",

journal = "Congenital Heart Disease",

issn = "1747-079X",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "1",

}

TY - JOUR

T1 - Dobutamine stress testing for the evaluation of atrial and diastolic ventricular function in Fontan patients

AU - van der Ven, Jelle

AU - Bossers, Sjoerd

AU - van den Bosch, Eva

AU - Dam, Niels

AU - Kuipers, Irene M.

AU - van Iperen, Gabrielle G.

AU - Kroft, Lucia J M

AU - Kapusta, L

AU - ten Harkel, ADJ (Arend)

AU - Helbing, W.A.

N1 - Funding Information: Funding JPGvdv, EvdB (grant 2013T091) and SSMB (grant 2008T037) are supported by a research grant from the Dutch Heart Foundation. Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2021/3/12

Y1 - 2021/3/12

N2 - Objective To assess the atrial and ventricular diastolic function response to dobutamine stress in Fontan patients, and to relate these measurements to exercise capacity and events during the follow-up. Methods We performed a secondary analysis of a cross-sectional multicentre study of Fontan patients with intra-atrial lateral tunnel (ILT) or extracardiac conduit (ECC) modification. Subjects underwent cardiac MRI during rest and low-dose dobutamine stress, and cardiopulmonary exercise testing. Atrial and diastolic ventricular function parameters were derived from volume-time curves. Medical records were abstracted for a composite end-point of death, listing for transplant, arrhythmia and reintervention. Spearman's r correlation tests and Cox proportional hazards models were used to assess the relation between the dobutamine response for atrial and diastolic ventricular function and outcomes, including exercise capacity. Results We included 57 patients (26 ECC; 31 ILT) aged 12.8 (IQR (10.3-15.5)) years. During dobutamine stress atrial cyclic volume change increased (3.0 (0.4-5.9) mL/m 2, p<0.001), as did early (1.9 (-1.6 to 3.6) mL/m 2, p=0.001) and late emptying volume (2.2 (0.2-4.4) mL/m 2, p<0.001). Ventricular early filling decreased (-1.6 (-5.7 to 0.7) mL/m 2,p=0.046) and ventricular late filling increased (1.0 (-0.4 to 3.4) mL/m 2,p<0.001) while stroke volume remained similar. Only for patients with the ECC modification, atrial early emptying volume increase correlated with peak oxygen uptake (ρ=0.66,p=0.002). No other parameter related to exercise capacity. During a median 7.1-year follow-up, 22 patients reached the composite endpoint. No parameter predicted events during the follow-up. Conclusions Dobutamine stress augmented atrial reservoir and pump function for Fontan patients. Atrial early emptying reserve related to exercise capacity in ECC patients. No other atrial or diastolic ventricular function parameter related to outcomes.

AB - Objective To assess the atrial and ventricular diastolic function response to dobutamine stress in Fontan patients, and to relate these measurements to exercise capacity and events during the follow-up. Methods We performed a secondary analysis of a cross-sectional multicentre study of Fontan patients with intra-atrial lateral tunnel (ILT) or extracardiac conduit (ECC) modification. Subjects underwent cardiac MRI during rest and low-dose dobutamine stress, and cardiopulmonary exercise testing. Atrial and diastolic ventricular function parameters were derived from volume-time curves. Medical records were abstracted for a composite end-point of death, listing for transplant, arrhythmia and reintervention. Spearman's r correlation tests and Cox proportional hazards models were used to assess the relation between the dobutamine response for atrial and diastolic ventricular function and outcomes, including exercise capacity. Results We included 57 patients (26 ECC; 31 ILT) aged 12.8 (IQR (10.3-15.5)) years. During dobutamine stress atrial cyclic volume change increased (3.0 (0.4-5.9) mL/m 2, p<0.001), as did early (1.9 (-1.6 to 3.6) mL/m 2, p=0.001) and late emptying volume (2.2 (0.2-4.4) mL/m 2, p<0.001). Ventricular early filling decreased (-1.6 (-5.7 to 0.7) mL/m 2,p=0.046) and ventricular late filling increased (1.0 (-0.4 to 3.4) mL/m 2,p<0.001) while stroke volume remained similar. Only for patients with the ECC modification, atrial early emptying volume increase correlated with peak oxygen uptake (ρ=0.66,p=0.002). No other parameter related to exercise capacity. During a median 7.1-year follow-up, 22 patients reached the composite endpoint. No parameter predicted events during the follow-up. Conclusions Dobutamine stress augmented atrial reservoir and pump function for Fontan patients. Atrial early emptying reserve related to exercise capacity in ECC patients. No other atrial or diastolic ventricular function parameter related to outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85102620766&partnerID=8YFLogxK

U2 - 10.1136/openhrt-2020-001487

DO - 10.1136/openhrt-2020-001487

M3 - Article

C2 - 33712485

SN - 1747-079X

VL - 8

JO - Congenital Heart Disease

JF - Congenital Heart Disease

IS - 1

M1 - e001487

ER -

Dobutamine stress testing for the evaluation of atrial and diastolic ventricular function in Fontan patients

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Cite this