Objective: To investigate the safety profile and effectiveness of adenosine as a pharmacological stressor in patients with known or suspected coronary artery disease who underwent cardiac magnetic resonance imaging perfusion study. Design: Case series.Setting: Regional hospital, Hong Kong. Patients:All patients who underwent adenosine stress cardiac magnetic resonance imaging from May 2013 to August 2013 were prospectively interviewed during the scan. Main outcome measures:Common side-effects of adenosine as well as any other discomfort experienced during the scan were recorded. Haemodynamic changes including systolic and diastolic blood pressure and pulse rate before and during adenosine administration were also recorded.Results: There were 98 consecutive patients with a mean (± standard deviation) age of 64.0 ± 11.4 years (range, 10-83 years) and mean body weight of 67.5 ± 12.0 kg. Male-to-female ratio was 2.5:1. Of the 98 patients interviewed, 62 (63.3%) experienced one or more adenosine-associated adverse effects.The safety and tolerability of adenosine as a pharmacological stressor in stress perfusion cardiac magnetic resonance imaging in the Chinese population IntroductionThe use of stress perfusion study in cardiac magnetic resonance imaging (CMR) for the evaluation of myocardial ischaemia or infarction has increased significantly over recent years. 1 It is increasingly used in patients with known or suspected coronary artery disease. The major advantage of CMR is that it does not involve ionising radiation and allows simultaneous assessment of myocardial perfusion, function, and visualisation of myocardial scar with high spatial and temporal resolution. Global and regional wall motion New knowledge added by this study • This is the first study of the safety and tolerability of adenosine in our locality. It showed that adenosine is an effective stressor for use in stress cardiovascular magnetic resonance imaging. Implications for clinical practice or policy • To familiarise clinicians with the workflow of adenosine stress cardiovascular magnetic resonance imaging and its contra-indications in order to facilitate its clinical use.• Adenosine stress cardiovascular magnetic resonance imaging is a safe and effective method to investigate ischaemic heart disease and should be more widely adopted in local clinical practice.