Dobutamine stress cardiac MRI is safe and feasible in pediatric patients with anomalous aortic origin of a coronary artery (AAOCA)

Abstract

Background: Risk strati cation 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 rst-pass perfusion and wall motion abnormalities (WMA) were assessed. Inter-observer agreement was assessed using kappa coe cient.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 signi cantly 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 (K= 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.

Coronary artery anomalies

“…In our institution, we initially used single photon emission computed tomography (SPECT) imaging; however, based on concerns for possible high false-positive and false-negative testing,20 we have transitioned to DS-CMRI. Our recent data evaluating adolescents with stress CMRI suggest that it is feasible with good reproducibility and safety; this study noted evidence of inducible hypoperfusion in 14% of patients using a first-pass perfusion technique, which improves the sensitivity of stress CMRI 21. There are not currently any data available directly comparing stress imaging modalities in this population.…”

Sport resumption and quality of life after surgical correction of anomalous origin of a coronary artery from the opposite sinus

“…Recent data have suggested that cardiopulmonary exercise test has an increased sensitivity for the detection of myocardial ischaemia ( 31 ). Finally, stress MRI has become an increasingly interesting and suitable modality for the detection of myocardial ischaemia in both children and adult patients with ACAOS ( 32 , 33 ). In our practice, we did not use a systemic cardiopulmonary exercise test and stress MRI for ACAOS evaluation, but considering these recent studies, we prefer to use these 2 modalities to detect inducible myocardial ischaemia in our future patients with ACAOS and for cardiac follow-up.…”

Surgery for Anomalous Aortic Origin of a Coronary Artery (AAOCA) in Children and Adolescents: A Meta-Analysis

“…We speculate that these numbers could overestimate the actual incidence of true cardiac symptoms after treatment because of the difficulty of discriminating real symptoms for younger patients and the proven absent association between subjective symptoms and objective tests of myocardial perfusion. 17 Dobutamine-stress cardiac magnetic resonance imaging is emerging as a safe and reliable noninvasive diagnostic technique 38,39 to unmask inducible myocardial ischemia in patients with subtle or even absent clinical manifestations, 40 representing a promising tool for the management of this challenging population.…”