Congenital Heart Disease

1352280 - Dobutamine Stress Cardiovascular Magnetic Resonance with Feature Tracking Strain Analysis in Pediatric Patients with Anomalous Aortic Origin of Right Coronary Artery

Friday, January 27, 2023

10:20 AM – 11:00 AM

Location: Pacific Jewel

Presenting Author(s)

PD

Pezad Doctor, MD

Pediatric Cardiology Fellow
The University of Texas Southwestern Medical Center
Dallas, Texas, United States

Co-Author(s)

BS

Bharti Sharma, MD

Resident
The University of Texas Southwestern Medical Center
Queens, Texas, United States
Gerald Greil, MD, PhD

Professor of Pediatric Cardiology
UT Southwestern
Dallas, Texas, United States
JD

Jeanne Dillenbeck, MD

Pediatric Radiology
The University of Texas Southwestern Medical Center
Dallas, Texas, United States
MA

Mubeena Abdulkarim, MD

Assisstant Professor
Nicklaus Children's Hospital, United States
RJ

Robert Jaquiss, MD

Pediatric and Congenital Cardiothoracic Surgery
UT Southwestern
Dallas, Texas, United States
Tarique Hussain, MD, PhD

Professor, Pediatric Cardiology & Radiology
UT Southwestern Medical Center
Dallas, Texas, United States

Primary Author(s)

MF

Munes Fares, MD

Assistant Professor
The University of Texas Southwestern Medical Center
Dallas, Texas, United States

Disclosure(s):

Gerald Greil, MD, PhD: No financial relationships to disclose

Background: Anomalous aortic origin of right coronary artery (AAORCA) is not always a benign condition as it may be associated with myocardial ischemia and sudden cardiac arrest/death. Therefore, various clinical decisions such as physical activity restriction, sports participation and the recommendation for surgical correction is fraught with uncertainty. The objective of this study is to report our experience with dobutamine stress cardiovascular magnetic resonance (DSCMR) and incremental benefit of feature tracking strain analysis (FT) for provocative ischemia testing in children with AAORCA.

Methods: In this IRB-approved retrospective single center study wherein all patients with AAORCA underwent DSCMR as a part their clinical work up between July 2018 and August 2022. Demographic, clinical, and other imaging data (TTE, CCT) were obtained from electronic medical records. DSCMR was performed on a 1.5-T scanner (Ingenia, Philips Healthcare) using a 32-channel torso coil. DSCMR protocol included visual assessment for regional wall motion abnormalities (WMA) on steady state free precession (SSFP) cine images (2-3-4-chamber, and three level short axis orientations) at rest and during protocolized increments of dobutamine infusion. Global and regional left ventricular circumferential and radial strain were calculated on SSFP SAX images (basal, mid, apical) using FT analysis (cvi42, Circle Cardiovascular Imaging Inc.) at rest and at peak heart rate

Results:

A total of 51 DSCMR studies were performed in 48 children with median age (interquartile range) of 13 (11– 15) years. Exertional symptoms in 17 (35%), non-exertional symptoms in 11 (23%). The remaining 20 (42%) patients were asymptomatic and detected incidentally [Table 1]. Two (4%) aged 13 and 14 years underwent surgical repair. Both reported exertional chest pain/syncope. CT with RCA intramural stenosis of > 25%. Five patients were noted to have mild degree of RCA stenosis (25 – 50%) but did not undergo surgical repair. Visual wall motion abnormalities were absent in all studies at rest or peak dobutamine stress. LGE assessment was performed in 16 patients and only one patient with history of recent myocarditis showed subepicardial LGE pattern. The median (IQR) absolute change in GCS from rest to peak dobutamine stress was 4 (1-6). There was no difference between GCS values at rest or peak heart rate achieved among patients with exertional symptoms compared to remaining of the cohort [Table 2]. No significant regional strain abnormalities noted in the RCA territory in any group.

Conclusion:

This study describes the use of CMR derived FT analysis during dobutamine provocative testing in children with AAORCA. There was no difference noted between those with exertional symptoms compared to non-exertional and asymptomatic patients. Absolute change in GCS between rest and peak exercise is less than that reported in adult studies. The study is limited due to its retrospective design.