CMR Right Ventricular Contractile Reserve Following Lung Resection

Belfast Health and Social Care Trust42 enrolled

Overview

Feasibility study investigating CMR dobutamine stress testing before and after lung resection

We hypothesise that following lung resection, 1. the subtle decrease in RV function and increase in afterload we have demonstrated at rest is associated with a marked impairment of RV function on exercise, termed impaired RV contractile reserve (RVCreserve), 2. impaired RVCreserve is associated with impaired functional capacity . In this study we aim to assess the feasibility of dobutamine stress cardiovascular magnetic resonance (CMR) scanning to assess RVCreserve pre- and post-operatively in patients undergoing lung resection. Additionally, we hypothesise that one lung ventilation (with and without lung resection) is associated with biomarker evidence of RV injury.We will perform peri-operative cardiac biomarkers to differentiate between the contribution of major surgery (gastrectomy, lung resection and oesophagectomy), one lung ventilation (lung resection and oesophagectomy) and lung resection on RV injury.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Lung Cancer Surgery Anesthesia

Interventions

Dobutamine stress CMRDIAGNOSTIC_TEST

Dobutamine stress testing will be undertaken in keeping with local departmental clinical guidelines with a graded increase in dobutamine infusion up to a maximum of 10microgram/kg/min. The patients' medications will be managed in keeping with the usual clinical practice and departmental guidelines. At rest and on each graded level of dobutamine infusion we will collect cine loops of the cardiac cycle including a short-axis stack of the ventricles, a four-chamber view and flow imaging perpendicular to the main, left and right pulmonary arteries. Post-processing will be dual reported by blinded observers using the Argus analysis software (Siemens) according to a standardised protocol. A safety report of each CMR scan will be generated by a consultant cardiologist, any abnormalities identified will be referred to the appropriate medical speciality and highlighted to the patient's clinical team.

Cardiac biomarker sampleDIAGNOSTIC_TEST

blood samples will be collected pre-operatively, in recovery, on post-operative days 1 and 2, and at 4-8 weeks post-operatively

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * 1\) Provision of informed consent 2) Age \>16 years 3) Planned elective 1. lobectomy lung resection or 2. oesophagectomy surgery with one lung ventilation or 3. gastrectomy Exclusion Criteria: 1. Pregnancy 2. On-going participation in any investigational research which could undermine the scientific basis of the study 3. Atrial fibrillation at baseline 4. Any contraindication to a. CMR, i. Cardiac pacemaker, artificial heart valve, neurostimulator, cochlear implant ii. Aneurysm clips iii. Metal injuries to the eye iv. Loose metal in a part of the body b. Dobutamine stress testing as per the Society for Cardiovascular Magnetic Resonance64 i. Severe systemic arterial hypertension (≥220/120 mmHg) ii. Unstable angina pectoris iii. Severe aortic valve stenosis (peak aortic valve gradient \>60mmHg or aortic valve area \< 1cm2) iv. Complex cardiac arrhythmias including uncontrolled atrial fibrillation v. Hypertrophic obstructive cardiomyopathy vi. Myocarditis, endocarditis, or pericarditis vii. Uncontrolled heart failure 5. Lung resection specific 1. Wedge, segmental or sub-lobar lung resection 2. Pneumonectomy 3. Isolated right middle lobectomy \-

Locations (1)

Belfast Health and Social Care Trust

Belfast, Northern Ireland, United Kingdom

RECRUITING

Outcomes

Primary Outcomes

1) Feasibility of dobutamine stress CMR to measure RVCreserve following lung resection.

Reliability and variability will be assessed through dual reporting of the CMR images, testing intra-/inter-observer intraclass correlation coefficient (ICC) and coefficient of variation (CV). Study design will allow comparison to our previous resting studies published exercise literature and between pre- and post-operative imaging.