P397Splenic Switch-off as a Predictor for Coronary Adenosine Response During Myocardial Perfusion Imaging: Evaluation Against 13N-ammonia PET/MR

Patriki, Dimitri; Felten, Elia von; Giannopoulos, A.; Kamani, C K; Schwyzer, Moritz; Messerli, Michael; Benz, David; Gebhard, Cathérine; Graeni, C; Pazhenkottil, Aju P.; Pa, Kaufmann; Fuchs, T F; Buechel, R B

doi:10.1093/ehjci/jez149.019

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“…Confl ict of interest: none declared. Inadequate coronary adenosine response is a potential cause for false negative ischemia testing 13 . Clinical parameters such as heart rate increase by 10 bpm and/or systolic blood pressure dropping by >10 mmHg are used to defi ne a maximal vasodilatory stress.…”

Section: Discussionmentioning

confidence: 99%

“…An adequate vasodilatory stress was defi ned when the patient experienced adenosine related symptoms (fl ushing, headache, chest pain/pressure palpitations, and breathlessness) and an increase in heart rate by >10 bpm. Additionally, the effi ciency of the vasodilatory stress was verifi ed with the splenic switch-off (SSO) phenomenon 13 (Figure 2). Hypoperfusion (ischaemia) was assessed by visual comparison of stress and rest CMR perfusion scans (16 segments of the 17 segment AHA/ACC model, excluding the apical cap segment) 8 .…”

Section: Cmr Interpretationmentioning

confidence: 95%

“…This is defi ned as a visible decrease in splenic signal intensity during adenosine stress as compared to rest (Figure 2). During adenosine-induced hypotension, the splenic blood fl ow is reduced presumably due reactive sympathetic vasoconstriction 13 . In our cohort, one of the patients who did not meet the clinical criteria for adequate adenosine response, had a reliable SSO appearance, however, for safety reasons, the test was reported as equivocal.…”

Section: Referencesmentioning

confidence: 99%

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Stress perfusion CMR – a report of an initial Romanian experience

Onciul¹,

Popa

Nicolaescu³

et al. 2021

Romanian Journal of Cardiology

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Objectives – To provide preliminary data on practice of stress perfusion cardiovascular magnetic resonance (CMR) in a single center in Romania. Methods – We retrospectively reviewed the clinical files and CMR reports of patients who underwent stress perfusion CMR in our institution between January 2018 and December 2020. Results – A total of 1036 patients underwent CMR examinations during this period in our institution. Of these, 120 patients had stress perfusion CMR. The most common indication was the assessment of myocardial ischaemia in patients with established coronary artery disease (CAD) (77 patients, 64.16%), with either a history of myocardial infarction or previous coronary revascularization, or with intermediate lesions on invasive coronary angiography (ICA). The other indications consisted in detection of ischaemia in patients with suspected CAD (36 patients, 30%), characterization of the substrate of ventricular arrhythmia (5 patients, 4.16%) and assessment of the etiology of dilated cardiomyopathy (DCM) (4 patients, 3.33%). All patients had vasodilator stress with adenosine and an adequate stress response was obtained in 113 patients (94.16%). There were 21 patients (18.58%) with an abnormal stress test and patients with intermediate lesions on ICA had the highest prevalence of positive reports (24.32%). Sixty-three patients had myocardial fibrosis (52.5%): 49 patients (40.83%) had subendocardial (ischaemic) scars, while 14 patients (11.66%) had non-ischaemic scars. There were no serious adverse events related to the procedure. Conclusions – This is the first report in Romania on the use of stress perfusion CMR in clinical practice. We report our experience on stress efficiency, acquisition protocol, artifacts, prevalence of positive tests and safety. Most stress CMRs were requested in patients with established CAD.

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Section: Discussionmentioning

confidence: 99%

Section: Cmr Interpretationmentioning

confidence: 95%

Section: Referencesmentioning

confidence: 99%

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