title: Assessment of cardiovascular physiology using dobutamine stress cardiovascular magnetic resonance reveals impaired contractile reserve in patients with cirrhotic cardiomyopathy.
abstract: BACKGROUND
  Liver cirrhosis has been shown to affect cardiac performance. However cardiac dysfunction may only be revealed under stress conditions. The value of non-invasive stress tests in diagnosing cirrhotic cardiomyopathy is unclear. We sought to investigate the response to pharmacological stimulation with dobutamine in patients with cirrhosis using cardiovascular magnetic resonance.
  
  
  METHODS
  Thirty-six patients and eight controls were scanned using a 1.5 T scanner (Siemens Symphony TIM; Siemens, Erlangen, Germany). Conventional volumetric and feature tracking analysis using dedicated software (CMR42; Circle Cardiovascular Imaging Inc, Calgary, Canada and Diogenes MRI; Tomtec; Germany, respectively) were performed at rest and during low to intermediate dose dobutamine stress.
  
  
  RESULTS
  Whilst volumetry based parameters were similar between patients and controls at rest, patients had a smaller increase in cardiac output during stress (p = 0.015). Ejection fraction increase was impaired in patients during 10 μg/kg/min dobutamine as compared to controls (6.9 % vs. 16.5 %, p = 0.007), but not with 20 μg/kg/min (12.1 % vs. 17.6 %, p = 0.12). This was paralleled by an impaired improvement in circumferential strain with low dose (median increase of 14.4 % vs. 30.9 %, p = 0.03), but not with intermediate dose dobutamine (median increase of 29.4 % vs. 33.9 %, p = 0.54). There was an impaired longitudinal strain increase in patients as compared to controls during low (median increase of 6.6 % vs 28.6 %, p < 0.001) and intermediate dose dobutamine (median increase of 2.6%vs, 12.6 % p = 0.016). Radial strain response to dobutamine was similar in patients and controls (p > 0.05).
  
  
  CONCLUSIONS
  Cirrhotic cardiomyopathy is characterized by an impaired cardiac pharmacological response that can be detected with magnetic resonance myocardial stress testing. Deformation analysis parameters may be more sensitive in identifying abnormalities in inotropic response to stress than conventional methods.
authors.affiliation: Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502 Vila Nova de Gaia, Espinho, Portugal. fpasampaio@gmail.com.|University of Porto Medical School, Porto, Portugal. fpasampaio@gmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sampaio
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, Kings College London, St. Thomas' Hospital, London, UK. pablo.lamata@kcl.ac.uk.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lamata
authors.affiliation: Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502 Vila Nova de Gaia, Espinho, Portugal. bettencourt.n@gmail.com.|University of Porto Medical School, Porto, Portugal. bettencourt.n@gmail.com.
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University, Göttingen, Germany. s.alt@stud.uni-goettingen.de.
authors.forename: Sophie Charlotte
authors.initials: SC
authors.lastname: Alt
authors.affiliation: Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502 Vila Nova de Gaia, Espinho, Portugal. ferreira.nmd@gmail.com.
authors.forename: Nuno
authors.initials: N
authors.lastname: Ferreira
authors.affiliation: Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany. jokowallick@yahoo.de.|DZHK (German Centre for Cardiovascular Research), Göttingen, Germany. jokowallick@yahoo.de.
authors.forename: Johannes Tammo
authors.initials: JT
authors.lastname: Kowallick
authors.affiliation: University of Porto Medical School, Porto, Portugal. joanamartinspimenta@gmail.com.
authors.forename: Joana
authors.initials: J
authors.lastname: Pimenta
authors.affiliation: University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, NE, USA. skutty@unmc.edu.
authors.forename: Shelby
authors.initials: S
authors.lastname: Kutty
authors.affiliation: Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Espinho, Portugal. jfraga@chvng.min-saude.pt.
authors.forename: José
authors.initials: J
authors.lastname: Fraga
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University, Göttingen, Germany. michael.steinmetz@med.uni-goettingen.de.|DZHK (German Centre for Cardiovascular Research), Göttingen, Germany. michael.steinmetz@med.uni-goettingen.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Steinmetz
authors.affiliation: University of Porto Medical School, Porto, Portugal. pbettfer@med.up.pt.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.affiliation: Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502 Vila Nova de Gaia, Espinho, Portugal. vasco@chvng.min-saude.pt.
authors.forename: Vasco
authors.initials: V
authors.lastname: Gama
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, Kings College London, St. Thomas' Hospital, London, UK. andreas.schuster@kcl.ac.uk.|DZHK (German Centre for Cardiovascular Research), Göttingen, Germany. andreas.schuster@kcl.ac.uk.|Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany. andreas.schuster@kcl.ac.uk.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuster
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D004280:Dobutamine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012984:Software; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine