多巴酚丁胺负荷试验评估 Fontan 患者的心房和舒张心室功能。
Dobutamine stress testing for the evaluation of atrial and diastolic ventricular function in Fontan patients.
机构信息
Pediatric Cardiology, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands.
Netherlands Heart Institute, Utrecht, Utrecht, The Netherlands.
出版信息
Open Heart. 2021 Mar;8(1). doi: 10.1136/openhrt-2020-001487.
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, p<0.001), as did early (1.9 (-1.6 to 3.6) mL/m, p=0.001) and late emptying volume (2.2 (0.2-4.4) mL/m, p<0.001).Ventricular early filling decreased (-1.6 (-5.7 to 0.7) mL/m,p=0.046) and ventricular late filling increased (1.0 (-0.4 to 3.4) mL/m,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.
目的
评估多巴酚丁胺负荷试验对 Fontan 患者心房和心室舒张功能的反应，并将这些测量值与随访期间的运动能力和事件相关联。
方法
我们对 Fontan 患者进行了一项横断面多中心研究的二次分析，这些患者接受了房间隔侧隧道（ILT）或心外管道（ECC）改良。患者在休息和低剂量多巴酚丁胺负荷下接受心脏 MRI，并进行心肺运动测试。从容积-时间曲线中得出心房和舒张心室功能参数。从病历中提取死亡、移植、心律失常和再干预的复合终点。采用 Spearman r 相关检验和 Cox 比例风险模型评估多巴酚丁胺对心房和舒张心室功能的反应与结局（包括运动能力）之间的关系。
结果
我们纳入了 57 名患者（26 名 ECC；31 名 ILT），年龄为 12.8（IQR（10.3-15.5））岁。在多巴酚丁胺负荷下，心房循环容积增加（3.0（0.4-5.9）mL/m，p<0.001），早期（1.9（-1.6 至 3.6）mL/m，p=0.001）和晚期排空容积也增加（2.2（0.2-4.4）mL/m，p<0.001）。心室早期充盈减少（-1.6（-5.7 至 0.7）mL/m，p=0.046），心室晚期充盈增加（1.0（-0.4 至 3.4）mL/m，p<0.001），而心排量保持不变。仅对于 ECC 改良的患者，心房早期排空容积增加与峰值摄氧量相关（ρ=0.66，p=0.002）。没有其他参数与运动能力相关。在中位数为 7.1 年的随访期间，有 22 名患者达到了复合终点。没有参数可以预测随访期间的事件。
结论
多巴酚丁胺负荷试验增强了 Fontan 患者的心房储备和泵功能。ECC 患者的心房早期排空储备与运动能力相关。没有其他心房或舒张心室功能参数与结局相关。
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