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Dobutamine Stress Cardiovascular Magnetic Resonance Derived 2-Dimension Feature Tracking Strain Analysis in Pediatric Population with Anomalous Aortic Origin of Right Coronary Artery

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Abstract

Anomalous aortic origin of right coronary artery (AAORCA) is associated with myocardial ischemia and sudden cardiac arrest/death. Risk stratification remains challenging and relies upon provocative test results. This study describes the utility of dobutamine stress cardiovascular magnetic resonance (DSCMR) and potential benefit of strain analysis in children with AAORCA. All patients less than 21 years of age with AAORCA who underwent DSCMR between July 2018 and December 2022 were included. Visual wall motion abnormalities (VWMA) at rest and during protocolized increments of dobutamine infusion were assessed. Regional and global left ventricular circumferential (GCS) and radial (GRS) strain using 2-dimension Feature tracking (2D-FT) analysis (cvi42, Circle Cardiovascular Imaging Inc.) were calculated at rest and peak response. Of the total 54 DSCMR studies performed in 51 children with median age (IQR) of 13.5 (11–15) years, FT analysis was reliably performed in 52 (96%) studies. None had VWMA. The absolute change in GCS and GRS from rest to peak dobutamine stress was 4% (1–6%) and 11% (4–18%), respectively. There was no significant difference in GCS and GRS in patients with exertional symptoms vs no/non-exertional symptoms as well as between those considered to be high-risk vs low-risk anatomical features. DSCMR-derived 2D-FT strain analysis is feasible to assess myocardial deformation in children with AAORCA and may enhance this method of provocative testing. Although there were no statically significant differences in GCS and GRS values between high and low-risk subgroups, the absolute change in GCS between rest and peak stress is diminished when compared to normal adult reports.

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Acknowledgements

The authors appreciate all the staff in the Division of Cardiac Imaging at Children's Health—UT Southwestern Medical Center for their continued support to make this work possible.

Funding

No funding was required for this study.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Children’s Health/University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA

    Pezad Doctor, Gerald Greil, Tarique Hussain & Munes Fares

  2. Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY, 11373, USA

    Bharti Sharma

  3. Department of Pediatric Radiology, Children’s Health/University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA

    Gerald Greil, Jeanne Dillenbeck & Tarique Hussain

  4. Department of Pediatric Cardiology, Nicklaus Children’s Hospital, 3100 SW 62n Ave, Miami, FL, 33155, USA

    Mubeena Abdulkarim

  5. Department of Pediatric Cardiovascular Thoracic Surgery, Children’s Health/University of Texas Southwestern Medical Center, 1935 Medical District Dr, Dallas, TX, 75235, USA

    Robert Jaquiss

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  1. Pezad Doctor
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  2. Bharti Sharma
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  3. Gerald Greil
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  5. Mubeena Abdulkarim
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  6. Robert Jaquiss
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  7. Tarique Hussain
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  8. Munes Fares
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Contributions

Material preparation, data collection and analysis were performed by PD, BS and MF. All authors contributed to the study conception and design. The first draft of the manuscript was written by PD and all authors commented on manuscript revision. All authors read and approved the final manuscript. The authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Correspondence to Pezad Doctor.

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This study was approved by the institutional review board of The University of Texas Southwestern Medical Center.

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The authors affirm that human research participants and their parents provided informed consent for publications of images.

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Doctor, P., Sharma, B., Greil, G. et al. Dobutamine Stress Cardiovascular Magnetic Resonance Derived 2-Dimension Feature Tracking Strain Analysis in Pediatric Population with Anomalous Aortic Origin of Right Coronary Artery. Pediatr Cardiol 45, 520–528 (2024). https://doi.org/10.1007/s00246-023-03401-9

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  • DOI: https://doi.org/10.1007/s00246-023-03401-9

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