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Dobutamine Stress Cardiac MRI in Pediatric Patients with Suspected Coronary Artery Disease

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Abstract

Following current practice, pediatric patients with treated congenital coronary malformations or acquired coronary disease undergo Cardio-Pulmonary Exercise Test (CPET), stress Echocardiography and Electrocardiography (sEcho, sEKG), and Coronary Angiography (CA). Stress cMRI can assess cardiac function, myocardial viability, and stress/rest perfusion deficit—without radiation exposure, general anesthesia, and hospitalization—in a single non-invasive exam. The aim of our pilot study is to assess the feasibility and diagnostic accuracy of Dobutamine stress cMRI compared to the current procedures (sEcho, CPET, CA). The prospective study is focused on pediatric patients, at risk for or with previously diagnosed coronary artery disease: d-looped TGA after arterial Switch, Kawasaki disease, and anomalous origin of left coronary artery from pulmonary artery (ALCAPA) after coronary artery reimplantation. We have compared the results of MRI coronary angiography, and Dobutamine stress cMRI with traditional tests. All these diagnostic exams were acquired in a timeframe of 3 month, in a blinded fashion. All the 13 patients (age: 12 ± 2 years, median 12,7 y) recruited, completed the study without major adverse events. The mean heart rate-pressure product was 25,120 ± 5110 bpm x mm Hg. The target heart rate of 85% of the maximal theoretical was reached by 10 (77%) patients. The comparison between cardiac MRI coronarography versus the gold standard Coronary Angiography to identify the patency of the origin and the proximal pathway of the coronary arteries shows a sensitivity of 100% (confidence interval: 2,5–100%), specificity 92% (confidence interval: 64–100%). The stress test was well tolerated for the 77% of the patients and completed by the totality of patients (Table 3). Three patients (23%) had mild symptoms: nausea, vomiting, or general discomfort. In pediatric patients with a potential or definite diagnosis of coronary artery disease, stress cMRI combines an effective assessment of proximal coronary arteries anatomy with cardiac function, myocardial perfusion, and viability in a single examination. Stress cMRI can be proposed as alternative, standalone test.

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Acknowledgements

The authors thank all the Technicians and Nurses of our Cardiac MRI Unit for their contribution, and in general to their dedication for Cardio-Radiology Team since its foundation in 2007. We thank Doctor Giollo for the trust and for the support to the project.

Funding

Guerbet (Villepinte, France) supported this study with an unrestricted grant provided to the Gaslini Hospital, but had no role in study design, data collection, analysis, interpretation, or writing of this report.

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Authors and Affiliations

  1. Radiology Unit, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, 16147, Genoa, Italy

    Nicola Stagnaro

  2. Department of Pediatric Cardiology, Royal Brompton Hospital, London, UK

    Sara Moscatelli

  3. Cardiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

    Martino Cheli, Sara Bondanza, Maurizio Marasini & Gianluca Trocchio

Authors
  1. Nicola Stagnaro
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  2. Sara Moscatelli
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  3. Martino Cheli
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  4. Sara Bondanza
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  5. Maurizio Marasini
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  6. Gianluca Trocchio
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Nicola Stagnaro and Gianluca Trocchio. The first draft of the manuscript was written by Nicola Stagnaro and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Nicola Stagnaro.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics Approval

This interventional, diagnostic study was conducted prospectively in a single center. The study was approved by Ethical Committee (Number: 519REG2016). The study is registered at Clinical Trials.gov (Identifiers: NCT04022395).

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Written informed consent was obtained from the parents.

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

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Study target and clinical impact: Our aim is to assess the diagnostic accuracy of stress cardiac MRI compared to the current procedures (Stress Echocardiography, Cardiopulmonary Exercise Test, Coronary Angiography), which are limited by hospitalization, a radiation dose, and with the inherent risk of invasive procedure under general anesthesia. Stress cardiac MRI represents a significative diagnostic improvement even for the patients who are unable to cooperate sufficiently for exercise stress testing or have poor acoustic windows. To our knowledge, this is the first study to assess the diagnostic accuracy of Dobutamine stress cardiac MRI, and to compare systematically the results with the available diagnostic techniques (Stress Echocardiography, Stress Electrocardiogram, Cardiopulmonary Exercise Test, Coronary Angiography) in pediatric patients with a suspected, or known coronary artery disease.

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Stagnaro, N., Moscatelli, S., Cheli, M. et al. Dobutamine Stress Cardiac MRI in Pediatric Patients with Suspected Coronary Artery Disease. Pediatr Cardiol 44, 451–462 (2023). https://doi.org/10.1007/s00246-022-03007-7

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