CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2020; 30(04): 459-464
DOI: 10.4103/ijri.IJRI_283_20
Cardiac Imaging

Safety profile of adenosine stress cardiac MRI in a tertiary hospital in India

Vimal Raj
Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bangalore, Karnataka, India
,
A Pudhiavan
Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bangalore, Karnataka, India
,
VJ Hrishikesh
Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bangalore, Karnataka, India
,
Asik Ali
Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bangalore, Karnataka, India
,
Richa Kothari
Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bangalore, Karnataka, India
› Author Affiliations
Financial support and sponsorship Nil.

Abstract

Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality in India. Stress Cardiac Magnetic Resonance (CMR) using vasodilator agent is well established in assessing the functional significance of CAD. Adenosine is the preferred agent, but can have severe side effects including dyspnoea, chest pain, atrioventricular block or bronchospasm. The stress CMR examination is not routinely performed in many of the clinical imaging departments in India. Objective: The aim of this study was to establish safety of adenosine as a pharmacological stressor agent for CMR in a tertiary care radiology department in India. Methods: A review of all patients undergoing stress CMR in our institution from May 2018 to May 2019 was made. Records were reviewed to collect response parameters and documented adverse reactions. Results: A total of 1057 patients underwent stress CMR during this period. No death, myocardial infarction or atrio-ventricular block related complications were seen. Transient hypotension was seen in 20 patients (1.8’) with spontaneous recovery after stopping infusion. Chest pain and breathlessness severe enough to discontinue the scan were seen in 6 (0.5’) and 10 (0.9’) patients, respectively. All patients with breathlessness recovered on low flow oxygen therapy with three requiring bronchodilator. Out of six patients with chest pain, three had immediate relief with sublingual nitroglycerin, and three required hospital admission for unstable angina. Of the latter three, 1 underwent revascularization on the same day and other two later in the week. Conclusion: Stress CMR using adenosine in appropriately selected patients is a highly safe procedure with significant side effects seen in less than 1’ of patients. Therefore, it is safe to perform stress CMR studies in a fully equipped and well-trained radiology department in India.



Publication History

Received: 23 April 2020

Accepted: 01 September 2020

Article published online:
14 July 2021

© 2020. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Christopher J, Raj V, Nukala S, Venugopal K. State of overall cardiovascular risk and imaging strategies in India. Curr Cardiovasc Imaging Rep 2015;8.
  • 2 Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart 2008; 94: 16-26
  • 3 Gupta S, Gudapati R, Gaurav K, Bhise M. Emerging risk factors for cardiovascular diseases: Indian context. Indian J Endocrinol Metab 2013; 17: 806-14
  • 4 Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study. Lancet 1997; 349: 1498-504
  • 5 Kwong RY, Ge Y, Steel K, Bingham S, Abdullah S, Fujikura K. et al. Cardiac magnetic resonance stress perfusion imaging for evaluation of patients with chest pain. J Am Coll Cardiol 2019; 74: 1741-55
  • 6 Schwitter J, Wacker CM, van Rossum AC, Lombardi M, Al-Saadi N, Ahlstrom H. et al. MR-IMPACT: Comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J 2008; 29: 480-9
  • 7 Schwitter J, Wacker CM, Wilke N, Al-Saadi N, Sauer E, Huettle K. et al. MR-IMPACT II: Magnetic resonance imaging for myocardial perfusion assessment in coronary artery disease trial: Perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: A comparative multicentre, multivendor trial. Eur Heart J 2013; 34: 775-81
  • 8 Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC. et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): A prospective trial. Lancet 2012; 379: 453-60
  • 9 Bingham SE, Hachamovitch R. Incremental prognostic significance of combined cardiac magnetic resonance imaging, adenosine stress perfusion, delayed enhancement, and left ventricular function over preimaging information for the prediction of adverse events. Circulation 2011; 123: 1509-18
  • 10 Bodi V, Sanchis J, Lopez-Lereu MP, Nunez J, Mainar L, Monmeneu JV. et al. Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease. J Am Coll Cardiol 2007; 50: 1174-9
  • 11 Lipinski MJ, McVey CM, Berger JS, Kramer CM, Salerno M. Prognostic value of stress cardiac magnetic resonance imaging in patients with known or suspected coronary artery disease: A systematic review and meta-analysis. J Am Coll Cardiol 2013; 62: 826-38
  • 12 Shah R, Heydari B, Coelho-Filho O, Murthy VL, Abbasi S, Feng JH. et al. Stress cardiac magnetic resonance imaging provides effective cardiac risk reclassification in patients with known or suspected stable coronary artery disease. Circulation 2013; 128: 605-14
  • 13 Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, Kramer CM. et al. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol 2014; 63: 380-406
  • 14 Cerqueira MD, Verani MS, Schwaiger M, Heo J, Iskandrian AS. Safety profile of adenosine stress perfusion imaging: Results from the Adenoscan Multicenter Trial Registry. J Am Coll Cardiol 1994; 23: 384-9
  • 15 Karamitsos TD, Arnold JR, Pegg TJ, Cheng AS, van Gaal WJ, Francis JM. et al. Tolerance and safety of adenosine stress perfusion cardiovascular magnetic resonance imaging in patients with severe coronary artery disease. Int J Cardiovasc Imaging 2009; 25: 277-83
  • 16 Khoo JP, Grundy BJ, Steadman CD, Sonnex EP, Coulden RA, McCann GP. Stress cardiovascular MR in routine clinical practice: Referral patterns, accuracy, tolerance, safety and incidental findings. Br J Radiol 2012; 85: e851-7
  • 17 Voigtlander T, Schmermund A, Bramlage P, Elsasser A, Magedanz A, Kauczor HU. et al. The adverse events and hemodynamic effects of adenosine-based cardiac MRI. Korean J Radiol 2011; 12: 424-30
  • 18 Kramer CM, Barkhausen J, Bucciarelli-Ducci C, Flamm SD, Kim RJ, Nagel E. Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update. J Cardiovasc Magn Reson 2020; 22: 17
  • 19 Kramer CM, Barkhausen J, Flamm SD, Kim RJ, Nagel E. Society for cardiovascular magnetic resonance board of trustees task force on standardized P. Standardized cardiovascular magnetic resonance (CMR) protocols 2013 update. J Cardiovasc Magn Reson 2013; 15: 91
  • 20 Hamon M, Fau G, Nee G, Ehtisham J, Morello R, Hamon M. Meta-analysis of the diagnostic performance of stress perfusion cardiovascular magnetic resonance for detection of coronary artery disease. J Cardiovasc Magn Reson 2010; 12: 29
  • 21 Schwitter J, Nanz D, Kneifel S, Bertschinger K, Buchi M, Knusel PR. et al. Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: A comparison with positron emission tomography and coronary angiography. Circulation 2001; 103: 2230-5
  • 22 Vogel-Claussen J, Skrok J, Dombroski D, Shea SM, Shapiro EP, Bohlman M. et al. Comprehensive adenosine stress perfusion MRI defines the etiology of chest pain in the emergency room: Comparison with nuclear stress test. J Magn Reson Imaging 2009; 30: 753-62
  • 23 Vasu S, Bandettini WP, Hsu LY, Kellman P, Leung S, Mancini C. et al. Regadenoson and adenosine are equivalent vasodilators and are superior than dipyridamole- a study of first pass quantitative perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2013; 15: 85
  • 24 Nishimura S, Nishimura T, Yamazaki J, Doi O, Konishi T, Iwasaki T. et al. Comparison of myocardial perfusion imaging by thallium-201 single-photon emission computed tomography with SUNY4001 (adenosine) and exercise--crossover clinical trial at multi-center. Kaku Igaku 2004; 41: 143-54