Pharmacological stress cardiovascular magnetic resonance: feasibility and safety in a large multicentre prospective registry

Menadas, J V Monmeneu; López‐Lereu, María P.; Erill, Jordi Estornell; González, Pilar; Igual, Begoña; González, Alicia

doi:10.1093/ehjci/jev153

Cited by 31 publications

(18 citation statements)

References 16 publications

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“…A comprehensive comparison of medications (adenosine, regadenoson, dipyridamole, and dobutamine) available for stress CMR is presented in TABLE 1. [39][40][41][42][43][44][45][46][47][48][49][50][51] Vasodilator stress perfusion cardiac magnetic resonance imaging During perfusion CMR, the first--pass transit of a gadolinium -based CM through the LV myocardium is observed under hyperemia mediated by infusion of a vasodilator. In the healthy myocardium, the coronary microvasculature dilates during exercise and stress ensuring suitable tissue perfusion, whereas for significantly stenosed coronary arteries, the distal microvasculature is almost maximally dilated under rest conditions and hyperemia provoked by vasodilators triggers a coronary steal effect.…”

mentioning

confidence: 99%

Cardiac magnetic resonance imaging to detect ischemia in chronic coronary syndromes: state of the art

Sokolska¹,

Spiczak²,

Gotschy³

et al. 2019

Kardiol Pol

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The new 2019 European Society of Cardiology guidelines for the diagnosis and management of chronic coronary syndromes emphasize the role of noninvasive functional imaging of myocardial ischemia in diagnosing coronary artery disease to guide decision making regarding revascularization. Cardiac magnetic resonance imaging (CMR) stands out relative to other imaging modalities given its high safety profile, absence of ionizing radiation, and its versatility in encoding various image contrasts. It also allows an assessment of myocardial function, ischemia, and viability as well as permits tissue characterization including detection of edema in a single examination. In recent years, a number of meta-analyses and studies considering the role of CMR for detecting ischemia have been published. The recent multicenter randomized MR-INFORM trial has demonstrated the clinical utility of CMR in patients with stable angina and cardiovascular risk factors. This landmark study has proved that a perfusion CMR-based strategy leads to a lower number of revascularizations while being noninferior to an invasive coronary angiography with fractional flow reserve-guided therapy in terms of major adverse cardiac events at 1 year. In light of recent and future technical improvements, CMR will become increasingly important in the assessment of myocardial ischemia in patients with chronic coronary syndromes.

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mentioning

confidence: 99%

Cardiac magnetic resonance imaging to detect ischemia in chronic coronary syndromes: state of the art

Sokolska¹,

Spiczak²,

Gotschy³

et al. 2019

Kardiol Pol

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“…The excellent safety profile of stress CMR was demonstrated in a large registry of 11,984 patients using dipyridamole or dobutamine ( 74 ) and in the EuroCMR registry assessing 10,228 patients referred for stress CMR ( 31 ). The incidence of severe complications and non-severe complications was low, at 0.08 and 1.5%, respectively ( 74 ) and 0.07 and 7.3%, respectively ( 31 ). Nephrogenic systemic fibrosis related to gadolinium contrast appears to be rare, with fewer than 1,000 cases reported.…”

Section: Safety and Limitations Of Stress Cmrmentioning

confidence: 99%

What Is the Clinical Impact of Stress CMR After the ISCHEMIA Trial?

Pezel

Silva

Bau

et al. 2021

Front. Cardiovasc. Med.

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After progressively receding for decades, cardiovascular mortality due to coronary artery disease has recently increased, and the associated healthcare costs are projected to double by 2030. While the 2019 European Society of Cardiology guidelines for chronic coronary syndromes recommend non-invasive cardiac imaging for patients with suspected coronary artery disease, the impact of non-invasive imaging strategies to guide initial coronary revascularization and improve long-term outcomes is still under debate. Recently, the ISCHEMIA trial has highlighted the fundamental role of optimized medical therapy and the lack of overall benefit of early invasive strategies at a median follow-up of 3.2 years. However, sub-group analyses excluding procedural infarctions with longer follow-ups of up to 5 years have suggested that patients undergoing revascularization had better outcomes than those receiving medical therapy alone. A recent sub-study of ISCHEMIA in patients with heart failure or reduced left ventricular ejection fraction (LVEF <45%) indicated that revascularization improved clinical outcomes compared to medical therapy alone. Furthermore, other large observational studies have suggested a favorable prognostic impact of coronary revascularization in patients with severe inducible ischemia assessed by stress cardiovascular magnetic resonance (CMR). Indeed, some data suggest that stress CMR-guided revascularization assessing the extent of the ischemia could be useful in identifying patients who would most benefit from invasive procedures such as myocardial revascularization. Interestingly, the MR-INFORM trial has recently shown that a first-line stress CMR-based non-invasive assessment was non-inferior in terms of outcomes, with a lower incidence of coronary revascularization compared to an initial invasive approach guided by fractional flow reserve in patients with stable angina. In the present review, we will discuss the current state-of-the-art data on the prognostic value of stress CMR assessment of myocardial ischemia in light of the ISCHEMIA trial results, highlighting meaningful sub-analyses, and still unanswered opportunities of this pivotal study. We will also review the available evidence for the potential clinical application of quantifying the extent of ischemia to stratify cardiovascular risk and to best guide invasive and non-invasive treatment strategies.

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“…In a recent large multicenter trial of nearly 12,000 patients, CMR showed a favorable safety profile with extremely low incidence of serious immediate complications [38]. Technological advances in CMR and automated image acquisition techniques are facilitating reduced scan time and increased utilization.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Updates on Stress Imaging Testing and Myocardial Viability With Advanced Imaging Modalities

Hedgire

Osborne

Verdini

et al. 2017

Curr Treat Options Cardio Med

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Pharmacological stress cardiovascular magnetic resonance: feasibility and safety in a large multicentre prospective registry

Abstract: Performance of stress CMR is safe in a referral population. Inducible ischaemia was the only factor identified which was associated with serious complications. The incidence of non-severe complications and minor symptoms was greater with dobutamine.

Cited by 31 publications

References 16 publications

Cardiac magnetic resonance imaging to detect ischemia in chronic coronary syndromes: state of the art

Cardiac magnetic resonance imaging to detect ischemia in chronic coronary syndromes: state of the art

What Is the Clinical Impact of Stress CMR After the ISCHEMIA Trial?

Updates on Stress Imaging Testing and Myocardial Viability With Advanced Imaging Modalities

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