多巴酚丁胺负荷心脏 MRI 在伴有冠状动脉异常起源（AAOCA）的儿科患者中是安全且可行的。
Dobutamine stress cardiac MRI is safe and feasible in pediatric patients with anomalous aortic origin of a coronary artery (AAOCA).
机构信息
Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA.
Coronary Artery Anomalies Program, Texas Children's Hospital, 6651 Main Street, MC E1920, Houston, TX 77030, USA; The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6651 Main Street, MC E1920, Houston, TX 77030, USA.
出版信息
Int J Cardiol. 2021 Jul 1;334:42-48. doi: 10.1016/j.ijcard.2021.04.031. Epub 2021 Apr 20.
BACKGROUND
Risk stratification in anomalous aortic origin of a coronary artery (AAOCA) is challenged by the lack of a reliable method to detect myocardial ischemia. We prospectively studied the safety and feasibility of Dobutamine stress-cardiac magnetic resonance (DSCMR), a test with excellent performance in adults, in pediatric patients with AAOCA.
METHODS
Consecutive DSCMR from 06/2014-12/2019 in patients≤20 years old with AAOCA were included. Hemodynamic response and major/minor events were recorded. Image quality and spatial/temporal resolution were evaluated. Rest and stress first-pass perfusion and wall motion abnormalities (WMA) were assessed. Inter-observer agreement was assessed using kappa coefficient.
RESULTS
A total of 224 DSCMR were performed in 182 patients with AAOCA at a median age of 14 years (IQR 12, 16) and median weight of 58.0 kg (IQR 43.3, 73.0). Examinations were completed in 221/224 (98.9%), all studies were diagnostic. Heart rate and blood pressure increased significantly from baseline (p < 0.001). No patient had major events and 28 (12.5%) had minor events. Inducible hypoperfusion was noted in 31/221 (14%), associated with WMA in 13/31 (42%). Inter-observer agreement for inducible hypoperfusion was very good (Κ = 0.87). Asymptomatic patients with inducible hypoperfusion are considered high-risk and those with a negative test are of standard risk.
CONCLUSIONS
DSCMR is feasible in pediatric patients with AAOCA to assess for inducible hypoperfusion and WMA. It can be performed safely with low incidence of major/minor events. Thus, DSCMR is potentially a valuable test for detection of myocardial ischemia and helpful in the management of this patient population.
背景
由于缺乏可靠的方法来检测心肌缺血，异常冠状动脉起源（AAOCA）的风险分层具有挑战性。我们前瞻性地研究了多巴酚丁胺负荷心脏磁共振（DSCMR）在 AAOCA 儿科患者中的安全性和可行性，该测试在成人中具有出色的性能。
方法
纳入 2014 年 6 月至 2019 年 12 月期间年龄≤20 岁的 AAOCA 患者连续进行的 DSCMR。记录血流动力学反应和主要/次要事件。评估图像质量和空间/时间分辨率。评估静息和应激首过灌注以及壁运动异常（WMA）。使用kappa 系数评估观察者间一致性。
结果
共对 182 例 AAOCA 患者进行了 224 次 DSCMR，中位年龄为 14 岁（IQR 12, 16），中位体重为 58.0kg（IQR 43.3, 73.0）。224 次检查中有 221 次（98.9%）完成，所有研究均为诊断性。心率和血压从基线显著增加（p < 0.001）。无患者发生重大事件，28 例（12.5%）发生轻微事件。221 例中 31 例（14%）出现可诱导性灌注不足，其中 13 例（42%）伴有 WMA。可诱导性灌注不足的观察者间一致性非常好（Κ=0.87）。有可诱导性灌注不足的无症状患者被认为是高危患者，而检测结果为阴性的患者为标准风险。
结论
DSCMR 可安全用于评估 AAOCA 儿科患者的可诱导性灌注不足和 WMA，具有低主要/次要事件发生率。因此，DSCMR 可能是一种有价值的检测心肌缺血的方法，有助于该患者人群的管理。
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