Real Time Myocardial Contrast Echocardiography and Dobutamine Stress Perfusion Magnetic Resonance Imaging
| Status: | Completed |
|---|---|
| Conditions: | Peripheral Vascular Disease, Cardiology, Endocrine |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Endocrinology |
| Healthy: | No |
| Age Range: | 12 - 50 |
| Updated: | 3/16/2019 |
| Start Date: | April 2009 |
| End Date: | March 2019 |
Quantification of Ventricular Mechanics/Myocardial Blood Flow Reserve in Adolescents and Adults Ages 12-50 With Congenital or Acquired Heart Disease Using Bicycle Stress With Real Time Myocardial Contrast Echo and Dobutamine Stress MRI
The present study is designed to:
1. investigate the safety and efficacy of Real time myocardial echocardiography (RT-MCE) in
adolescents and adults ages 12-50 with congenital and acquired congenital heart disease
2. compare RT-MCE with dobutamine stress perfusion MR for determination of coronary flow
reserve and ventricular wall motion
3. assess regional myocardial mechanics using myocardial speckle tracking and MR tagging.
4. evaluate RV volume and function for a subset of subjects using novel reconstruction
software
1. investigate the safety and efficacy of Real time myocardial echocardiography (RT-MCE) in
adolescents and adults ages 12-50 with congenital and acquired congenital heart disease
2. compare RT-MCE with dobutamine stress perfusion MR for determination of coronary flow
reserve and ventricular wall motion
3. assess regional myocardial mechanics using myocardial speckle tracking and MR tagging.
4. evaluate RV volume and function for a subset of subjects using novel reconstruction
software
Individuals will be identified from the cardiology database and consented during their
routine follow up visits. Exercise stress, transthoracic echocardiography and cardiac MR are
part of standard medical care in the follow up evaluation of adolescents and adults with
repaired congenital heart disease. The use of contrast (with transthoracic echocardiography)
and dobutamine stress testing (with the cardiac MR) will be performed as part of the research
study. After signing consent/ assent, a study subject will have pertinent medical history
(e.g. past palliation and operative repair dates and type, current medications, review of
systems) and physical exam findings extracted from the medical record, especially the
recording of the most recent clinic visit. If the subject is a female of child bearing age, a
serum pregnancy test will be done at this time. This data will be recorded using standardized
case report forms for history and physical exam. The study patients will complete a
standardized interview to determine their exercise tolerance according to New York Heart
Association (NYHA) classification. All patients who consent to the additional testing will
require an additional 1 hour of time to the regular Echo and CMR testing.
Each patient will have the protocol supine bicycle stress with contrast echocardiogram
performed at UNMC Echo lab.. The study subject will then have the clinically indicated CMR
study (Philips Achieva 1.5T magnet), scheduled and performed by a qualified CMR technologist,
working with a pediatric or adult cardiologist. An attempt will be made to have CMR and Echo
performed on the same day to minimize physiologic variability, but will at least be done
within 1 week each other. Further post-processing (wall motion analyses, speckle tracking and
myocardial tagging) and image analyses will be performed by the principal investigators on
standard workstations.
routine follow up visits. Exercise stress, transthoracic echocardiography and cardiac MR are
part of standard medical care in the follow up evaluation of adolescents and adults with
repaired congenital heart disease. The use of contrast (with transthoracic echocardiography)
and dobutamine stress testing (with the cardiac MR) will be performed as part of the research
study. After signing consent/ assent, a study subject will have pertinent medical history
(e.g. past palliation and operative repair dates and type, current medications, review of
systems) and physical exam findings extracted from the medical record, especially the
recording of the most recent clinic visit. If the subject is a female of child bearing age, a
serum pregnancy test will be done at this time. This data will be recorded using standardized
case report forms for history and physical exam. The study patients will complete a
standardized interview to determine their exercise tolerance according to New York Heart
Association (NYHA) classification. All patients who consent to the additional testing will
require an additional 1 hour of time to the regular Echo and CMR testing.
Each patient will have the protocol supine bicycle stress with contrast echocardiogram
performed at UNMC Echo lab.. The study subject will then have the clinically indicated CMR
study (Philips Achieva 1.5T magnet), scheduled and performed by a qualified CMR technologist,
working with a pediatric or adult cardiologist. An attempt will be made to have CMR and Echo
performed on the same day to minimize physiologic variability, but will at least be done
within 1 week each other. Further post-processing (wall motion analyses, speckle tracking and
myocardial tagging) and image analyses will be performed by the principal investigators on
standard workstations.
Inclusion Criteria:• Age between 12 years and 50 years.
- Male or female.
- History of repaired congenital heart disease including atrial septal defects, aortic
valve disease, tetralogy of fallot, transposition of great arteries and anomalous left
coronary artery from pulmonary artery.
- History of sequelae of heart disease acquired as an infant or child, including
Kawasaki disease and coronary ectasia, and patients post anthracycline chemotherapy.
- Ability to perform Supine bicycle stress with contrast echocardiography as determined
by primary cardiologist and/or Dr. Shelby Kutty.
- Ability to perform CMR with dobutamine stress as determined by the patients primary
cardiologist and/or Dr. Shelby Kutty
- Signed informed consent and assent as applicable.
Exclusion Criteria:• Atrial or ventricular arrythmias that cannot be controlled to heart
rates < 70/min
- Intracardiac shunts
- Known hypersensitivity to perflutren
- Known hypersensitivity to Dobutamine
- Congestive heart failure in NYHA class II, III or IV
- Claustrophobia or any other reason patient is unable to perform CMR (i.e.
ferromagnetic implants causing significant artifact that alters image quality,
presence of pacemaker, AICD, etc.)
- Pregnant or possibly pregnant (based on history/information obtained from the patient)
or breast feeding
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