Objective: The use of stress cardiovascular MR (CMR) to evaluate myocardial ischaemia has increased significantly over recent years. We aimed to assess the indications, incidental findings, tolerance, safety and accuracy of stress CMR in routine clinical practice. Methods: We retrospectively examined all stress CMR studies performed at our tertiary referral centre over a 20-month period. Patients were scanned at 1.5 T, using a standardised protocol with routine imaging for late gadolinium enhancement. Angiograms of patients were assessed by an interventional cardiologist blinded to the CMR data. Results: 654 patients were scanned (mean age 65¡29 years; 63 inpatients; 9.6%). 14% of patients had incidental extracardiac findings, the commonest being liver or renal cysts (6%) and pulmonary nodules (4%). 639 patients (97.7%) received intravenous adenosine, 10 received intravenous dobutamine and 5 patients had both. Of the 15 patients who received dobutamine, 12 had no side-effects/complications, 2 experienced nausea and 1 chest tightness. Of the 644 patients who received adenosine, 43% experienced minor symptoms, 1% had transient heart block and 0.2% had severe bronchospasm requiring termination of infusion. There were no cases of hospitalisation or myocardial infarction. 241 patients also had coronary angiography. For detecting at least moderate stenosis of $50%, sensitivity was 86%, specificity 98% and accuracy 89%. For detecting severe stenoses of $70%, sensitivity was 91%, specificity 86% and overall accuracy 90%. These results compare very favourably with previous smaller research studies and meta-analyses. Conclusion: We conclude that stress CMR, with adenosine as the main stress agent, is well tolerated, safe and accurate in routine clinical practice. The routine use of stress cardiovascular MR (CMR) to evaluate myocardial ischaemia has increased significantly over the last few years [1,2]. Stress CMR is an attractive non-invasive technique because it does not require radiation exposure, and it can potentially play an important role in the diagnosis and management of patients with coronary artery disease. More recent studies have also demonstrated that stress CMR results have important prognostic value: a negative result predicts a 3-year event-free survival of .99% and a positive result is an independent predictor of future cardiac events [3,4].Studies are usually performed during first-pass perfusion imaging, using vasodilatory pharmacological stress with either intravenous adenosine or dipyridamole [2]. Adenosine is the most widely used, and, in the presence of coronary stenoses, flow heterogeneities result in regional perfusion defects during firstpass gadolinium contrast imaging. Alternatively, if adenosine is contraindicated, myocardial ischaemia could also be assessed by regional wall motion abnormalities with dobutamine as an inotropic stress agent.Despite the increasing use of stress CMR clinically, previous research studies have involved relatively small numbers. A recent study examined the safety an...