Tolerance and safety of adenosine stress perfusion cardiovascular magnetic resonance imaging in patients with severe coronary artery disease

Karamitsos, Theodoros D.; Arnold, Jayanth R.; Pegg, Tammy; Cheng, Adrian S. H.; Gaal, William J. van; Francis, Jane M; Banning, Adrian P.; Neubauer, Stefan; Selvanayagam, Joseph B.

doi:10.1007/s10554-008-9392-3

Cited by 46 publications

(32 citation statements)

References 18 publications

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“…All other side effects were infrequent. This number of subjective adverse events was low when compared to that of other studies, which reported mild symptoms such as flushing, breathlessness or chest discomfort in up to 45% (15) and 63% (18) of the subjects. This is probably due to the selected patient populations with severe coronary artery disease within those previous studies.…”

Section: Discussioncontrasting

confidence: 67%

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The Adverse Events and Hemodynamic Effects of Adenosine-Based Cardiac MRI

et al. 2011

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Objective: We wanted to prospectively assess the adverse events and hemodynamic effects associated with an intravenous adenosine infusion in patients with suspected or known coronary artery disease and who were undergoing cardiac MRI. Materials and Methods: One hundred and sixty-eight patients (64 ± 9 years) received adenosine (140 µg/kg/min) during cardiac MRI. Before and during the administration, the heart rate, systemic blood pressure, and oxygen saturation were monitored using a MRI-compatible system. We documented any signs and symptoms of potential adverse events. Results: In total, 47 out of 168 patients (28%) experienced adverse effects, which were mostly mild or moderate. In 13 patients (8%), the adenosine infusion was discontinued due to intolerable dyspnea or chest pain. No high grade atrioventricular block, bronchospasm or other life-threatening adverse events occurred. The hemodynamic measurements showed a significant increase in the heart rate during adenosine infusion (69.3 ± 11.7 versus 82.4 ± 13.0 beats/min, respectively; p < 0.001). A significant but clinically irrelevant increase in oxygen saturation occurred during adenosine infusion (96 ± 1.9% versus 97 ± 1.3%, respectively; p < 0.001). The blood pressure did not significantly change during adenosine infusion (systolic: 142.8 ± 24.0 versus 140.9 ± 25.7 mmHg; diastolic: 80.2 ± 12.5 mmHg versus 78.9 ± 15.6, respectively). Conclusion: This study confirms the safety of adenosine infusion during cardiac MRI. A considerable proportion of all patients will experience minor adverse effects and some patients will not tolerate adenosine infusion. However, all adverse events can be successfully managed by a radiologist. The increased heart rate during adenosine infusion highlights the need to individually adjust the settings according to the patient, e.g., the number of slices of myocardial perfusion imaging.

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Section: Discussioncontrasting

confidence: 67%

“…Previous studies have been published on the adverse events of adenosine in the setting of CMR (15,17,18).…”

Section: Discussionmentioning

confidence: 99%

The Adverse Events and Hemodynamic Effects of Adenosine-Based Cardiac MRI

et al. 2011

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“…Affected coronaries fail to dilate properly resulting in a coronary steal phenomenon, manifested as a non-homogenous increase in coronary blood flow, which is reflected in the non-homogeneous distribution of the radio-isotope that can be mapped using a gamma-camera. Adenosine and ATP, and more recently a selective A2AR agonist (Lexiscan [458]), have been used as pharmacologic stressors in this setting [746][747][748][749][750][751][752][753][754]. The use of adenosine-cardiac magnetic resonance imaging for the detection of CAD has been recommended recently [755][756][757].…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Cardiac purinergic signalling in health and disease

Burnstock

Pelleg

2014

Purinergic Signalling

119

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This review is a historical account about purinergic signalling in the heart, for readers to see how ideas and understanding have changed as new experimental results were published. Initially, the focus is on the nervous control of the heart by ATP as a cotransmitter in sympathetic, parasympathetic, and sensory nerves, as well as in intracardiac neurons. Control of the heart by centers in the brain and vagal cardiovascular reflexes involving purines are also discussed. The actions of adenine nucleotides and nucleosides on cardiomyocytes, atrioventricular and sinoatrial nodes, cardiac fibroblasts, and coronary blood vessels are described. Cardiac release and degradation of ATP are also described. Finally, the involvement of purinergic signalling and its therapeutic potential in cardiac pathophysiology is reviewed, including acute and chronic heart failure, ischemia, infarction, arrhythmias, cardiomyopathy, syncope, hypertrophy, coronary artery disease, angina, diabetic cardiomyopathy, as well as heart transplantation and coronary bypass grafts.

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“…A recent study examined the safety and tolerance of stress CMR in 351 subjects, but 46 of these were healthy, normal volunteers [5]. A current metaanalysis of 35 studies, which included 13-229 patients, revealed a high sensitivity of 89% but only a moderate specificity of 80% [6].…”

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confidence: 99%

Stress cardiovascular MR in routine clinical practice: referral patterns, accuracy, tolerance, safety and incidental findings

Khoo¹,

Grundy²,

Steadman³

et al. 2012

BJR

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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...

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Tolerance and safety of adenosine stress perfusion cardiovascular magnetic resonance imaging in patients with severe coronary artery disease

Cited by 46 publications

References 18 publications

The Adverse Events and Hemodynamic Effects of Adenosine-Based Cardiac MRI

The Adverse Events and Hemodynamic Effects of Adenosine-Based Cardiac MRI

Cardiac purinergic signalling in health and disease

Stress cardiovascular MR in routine clinical practice: referral patterns, accuracy, tolerance, safety and incidental findings

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