Factors Determining Inadequate Stress Response to Adenosine Triphosphate in Perfusion Cardiovascular Magnetic Resonance

Abstract

Adenosine triphosphate (ATP) is an established pharmacological agent for stress cardiovascular magnetic resonance (CMR) in the Asia Pacific region. Inadequate cardiac stress in a CMR study may lead to false-negative results. The aim of the present study is to identify the proportion of patients with inadequate stress using a 140 mcg/kg/min protocol and the factors for inadequate stress in ATP stress CMR. Materials and Methods: A retrospective analysis from January to December 2017 was performed. In total, 150 patients underwent ATP stress perfusion CMR at 1.5 tesla. All patients received ATP infusion of 140 mcg/kg/min for 4 min. Adequate stress was defined as two or more of the following criteria: 1) positive splenic switch off sign, 2) increased heart rate ≥10 bpm, and 3) drop in systolic blood pressure ≥10 mm Hg. Multivariable logistic regression analysis with forward and backward stepwise selection was used to identify predictors of inadequate response to ATP. Basic demographic variables with p-value ≤0.2 were examined for inclusion in the model. A p-value less than 0.05 was considered significant. Results: Fifty-six (37%) patients did not demonstrate adequate cardiac stress response. Non-responders to ATP more often had atrial fibrillation, higher indexed left ventricular end systolic volume, and lower ejection fraction. Multivariable logistic regression analysis showed that low body weight and male gender were consistent independent predictors of inadequate stress in all models. Conclusion: Inadequate stress occurred in 37% of subjects with ATP infusion of 140 mcg/kg/ min. Low body weight and male gender are independent predictors of inadequate response to ATP. Higher infusion rates of ATP should be considered in patients with inadequate stress.

Inadequate Response to Adenosine Infusion During Cardiac Stress Magnetic Resonance Imaging

“…In a study conducted by Cheng et al ,[ 15 ] 56 of 150 patients (37%) did not show adequate stress response with an adenosine triphosphate (ATP) infusion rate of 140 mcg/kg/min. Karamitsos et al [ 16 ] demonstrated that 18% of patients did not achieve adequate hemodynamic stress under the standard dose of 140 ug/kg/min.…”

“…Cheng et al [ 15 ] found that low body weight and male gender were independent predictors of an inadequate stress response.…”