Background: In patients with complex congenital heart disease (CHD) abnormal ventricular stress responses have been reported with dobutamine stress cardiovascular magnetic resonance (DCMR). These abnormal stress responses are potential indicators of long-term outcome. However, safety and reproducibility of this technique has not been reported in a larger study. The aim of this study was to report our experiences regarding safety and intra-observer and inter-observer variability of low-dose DCMR in complex CHD. Methods: In 91 patients, 110 low-dose DCMR studies were performed with acquisition of a short axis set at rest, and during dobutamine administration (7.5 μg/kg/min maximum). We assessed biventricular end-diastolic volumes, end-systolic volumes, stroke volumes, ejection fraction and ventricular mass. Intra- and inter-observer variability for all variables was assessed by calculating the coefficient of variation (%), i.e. the standard deviation of the difference divided by the mean of 2 measurements multiplied by 100%. Results: In 3 patients minor side effects occurred (vertigo, headache, and bigeminy). Ten patients experienced an increase in heart rate of > 150% from baseline, although well tolerated. For all variables, intra-observer variability was < 10% at rest and during stress. At rest, inter-observer variability was 10.5% maximal. With stress-testing, only the variability of biventricular end-systolic volumes (ESV) exceeded 10%. Conclusions: In patients with complex CHD low-dose DCMR is feasible, and safe. Intra-observer variability is low for rest and stress measurements. Inter-observer variability of biventricular ESV is high with stress-testing. Whether this limits the potential usefulness of DCMR for risk assessment during follow-up has to be assessed.

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International Journal of Cardiology
Erasmus MC: University Medical Center Rotterdam

Robbers-Visser, D., Luijnenburg, S., Roos-Hesselink, J., Strengers, J., Kapusta, L., Moelker, A., & Helbing, W. (2011). Safety and observer variability of cardiac magnetic resonance imaging combined with low-dose dobutamine stress-testing in patients with complex congenital heart disease. International Journal of Cardiology, 147(2), 214–218. doi:10.1016/j.ijcard.2009.08.024