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Abnormal myocardial blood flow in children with mild/moderate aortic stenosis

Published online by Cambridge University Press:  10 February 2015

Erin Madriago ,
Ronald Wells ,
David J. Sahn ,
Brian S. Diggs ,
Stephen M. Langley ,
Daniel J. Woodward ,
Michael Jerosch-Herold  and
Michael Silberbach
Erin Madriago
Affiliation:
Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, United States of America
Ronald Wells
Affiliation:
Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, United States of America
David J. Sahn
Affiliation:
Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, United States of America
Brian S. Diggs
Affiliation:
Department of Surgery, Oregon Health & Science University, Portland, Oregon, United States of America
Stephen M. Langley
Affiliation:
Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, United States of America Department of Surgery, Oregon Health & Science University, Portland, Oregon, United States of America
Daniel J. Woodward
Affiliation:
Department of Anesthesiology, Oregon Health & Science University, Portland, Oregon, United States of America
Michael Jerosch-Herold
Affiliation:
Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
Michael Silberbach*
Affiliation:
Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, United States of America
*
Correspondence to: Dr Michael Silberbach, MD, Division of Pediatric Cardiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America. Tel: +(503) 494-2192; Fax +(503) 418-5793; E-mail: [email protected]
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Abstract

Objective

To quantify myocardial blood flow in infants and children with mild or moderate aortic stenosis using adenosine-infusion cardiac magnetic resonance.

Background

It is unclear whether asymptomatic children with mild/moderate aortic stenosis have myocardial abnormalities. In addition, cardiac magnetic resonance-determined normative myocardial blood flow data in children have not been reported.

Methods

We studied 31 infants and children with either haemodynamically normal hearts (n=20, controls) or mild/moderate aortic stenosis (n=11). The left ventricular myocardium was divided into six segments, and the change in average segmental signal intensity during contrast transit was used to quantify absolute flow (ml/g/minute) at rest and during adenosine infusion by deconvolution of the tissue curves with the arterial input of contrast.

Results

In all the cases, adenosine was well tolerated without complications. The mean pressure gradient between the left ventricle and the ascending aorta was higher in the aortic stenosis group compared with controls (24 versus 3 mmHg, p<0.001). Left ventricular wall mass was slightly higher in the aortic stenosis group compared with controls (65 versus 50 g/m2, p<0.05). After adenosine treatment, both the absolute increase in myocardial blood flow (p<0.0001) and the hyperaemic flow significantly decreased (p<0.001) in children with mild/moderate aortic stenosis compared with controls.

Conclusion

Abnormal myocardial blood flow in children with mild/moderate aortic stenosis may be an important therapeutic target.

Keywords

Congenital heart diseaseaortic stenosisperfusionfibrosiscontrast media
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 7 , October 2015 , pp. 1358 - 1366
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Copyright
© Cambridge University Press 2015 

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References

1. Azevedo, CF, Nigri, M, Higuchi, ML, et al. Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. J Am Coll Cardiol 2010; 56: 278–287.CrossRefGoogle ScholarPubMed
2. Weidemann, F, Herrmann, S, Stork, S, et al. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation 2009; 120: 577–584.CrossRefGoogle ScholarPubMed
3. Flett, AS, Sado, DM, Quarta, G, et al. Diffuse myocardial fibrosis in severe aortic stenosis: an equilibrium contrast cardiovascular magnetic resonance study. Eur Heart J Cardiovasc Imaging 2012; 13: 819–826.CrossRefGoogle ScholarPubMed
4. Marcus, ML, Harrison, DG, Chilian, WM, et al. Alterations in the coronary circulation in hypertrophied ventricles. Circulation 1987; 75: I19–I25.Google ScholarPubMed
5. Constantine, G, Shan, K, Flamm, SD, Sivananthan, MU. Role of MRI in clinical cardiology. The Lancet 2004; 363: 2162–2171.CrossRefGoogle ScholarPubMed
6. Wang, L, Jerosch-Herold, M, Jacobs, DR Jr, Shahar, E, Folsom, AR. Coronary risk factors and myocardial perfusion in asymptomatic adults: the multi-ethnic study of atherosclerosis (mesa). J Am Coll Cardiol 2006; 47: 565–572.CrossRefGoogle ScholarPubMed
7. Kramer, CM, Barkhausen, J, Flamm, SD, Kim, RJ, Nagel, E. Standardized cardiovascular magnetic resonance imaging (cMR) protocols, society for cardiovascular magnetic resonance: board of trustees task force on standardized protocols. J Cardiovasc Magn Reson 2008; 10: 35.CrossRefGoogle ScholarPubMed
8. Jerosch-Herold, M, Seethamraju, RT, Swingen, CM, Wilke, NM, Stillman, AE. Analysis of myocardial perfusion MRI. J Magn Reson Imaging 2004; 19: 758–770.CrossRefGoogle ScholarPubMed
9. Petersen, SE, Jerosch-Herold, M, Hudsmith, LE, et al. Evidence for microvascular dysfunction in hypertrophic cardiomyopathy: new insights from multiparametric magnetic resonance imaging. Circulation 2007; 115: 2418–2425.CrossRefGoogle ScholarPubMed
10. Team RDC. R: A language and environment for statistical computing (http://www.R-project.Org/). R Foundation for Statistical Computing; Institute for Statistics and Mathematics, Wirtschaftsuniversität Wien Welthandelsplatz 1, Vienna, Austria, 2010.Google Scholar
11. Roccella, E. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555–576.Google Scholar
12. Jahnke, C, Nagel, E, Gebker, R, et al. Prognostic value of cardiac magnetic resonance stress tests: adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation 2007; 115: 1769–1776.CrossRefGoogle ScholarPubMed
13. Chareonthaitawee, P, Kaufmann, PA, Rimoldi, O, Camici, PG. Heterogeneity of resting and hyperemic myocardial blood flow in healthy humans. Cardiovasc Res 2001; 50: 151–161.CrossRefGoogle ScholarPubMed
14. Rosen, BD, Lima, JA, Nasir, K, et al. Lower myocardial perfusion reserve is associated with decreased regional left ventricular function in asymptomatic participants of the multi-ethnic study of atherosclerosis. Circulation 2006; 114: 289–297.CrossRefGoogle ScholarPubMed
15. Puchalski, MD, Williams, RV, Askovich, B, et al. Late gadolinium enhancement: precursor to cardiomyopathy in duchenne muscular dystrophy? Int J Cardiovasc Imaging 2009; 25: 57–63.CrossRefGoogle ScholarPubMed
16. Wicker, P, Tarazi, RC. Coronary blood flow in left ventricular hypertrophy: a review of experimental data. Eur Heart J 1982; 3 (Suppl A): 111–118.CrossRefGoogle ScholarPubMed
17. Hoffman, JI. Problems of coronary flow reserve. Ann Biomed Eng 2000; 28: 884–896.CrossRefGoogle ScholarPubMed
18. Rakusan, K, Flanagan, MF, Geva, T, Southern, J, Van Praagh, R. Morphometry of human coronary capillaries during normal growth and the effect of age in left ventricular pressure-overload hypertrophy. Circulation 1992; 86: 38–46.CrossRefGoogle ScholarPubMed
19. Feldman, AM, Cheksis-Feiner, E, Hamad, E, Chan, T. Adenosine receptor subtypes and the heart failure phenotype: translating lessons from mice to man. Trans Am Clin Climatol Assoc 2011; 122: 198–214.Google ScholarPubMed
20. Funabiki, K, Onishi, K, Dohi, K, et al. Combined angiotensin receptor blocker and ace inhibitor on myocardial fibrosis and left ventricular stiffness in dogs with heart failure. Am J Physiol Heart Circ Physiol 2004; 287: H2487–H2492.CrossRefGoogle ScholarPubMed
21. Hudson, MP, Armstrong, PW, Ruzyllo, W, et al. Effects of selective matrix metalloproteinase inhibitor (pg-116800) to prevent ventricular remodeling after myocardial infarction: results of the premier (prevention of myocardial infarction early remodeling) trial. J Am Coll Cardiol 2006; 48: 15–20.CrossRefGoogle ScholarPubMed
22. Kaye, DM, Krum, H. Drug discovery for heart failure: a new era or the end of the pipeline? Nature reviews . Drug Disc 2007; 6: 127–139.CrossRefGoogle ScholarPubMed
23. Sata, Y, Krum, H. The future of pharmacological therapy for heart failure. Circ J 2010; 74: 809–817.CrossRefGoogle ScholarPubMed
24. Young, MJ, Lam, EY, Rickard, AJ. Mineralocorticoid receptor activation and cardiac fibrosis. Clin Sci (Lond) 2007; 112: 467–475.CrossRefGoogle ScholarPubMed
25. Dietrich, O, Reiser, MF, Schoenberg, SO. Artifacts in 3-T MRI: physical background and reduction strategies. Eur J Radiol 2008; 65: 29–35.CrossRefGoogle ScholarPubMed
26. Berry, C, Balachandran, KP, L’Allier, PL, Lesperance, J, Bonan, R, Oldroyd, KG. Importance of collateral circulation in coronary heart disease. Eur Heart J 2007; 28: 278–291.CrossRefGoogle ScholarPubMed