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

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.

Safety and clinical impact of adenosine stress perfusion cardiac magnetic resonance in Asian patients with known or suspected coronary artery disease

“…Adenosine stress CMR has also demontrated a favorable safety profile in several studies conducted in Western countries [ 4 , 15 ]. The safety of adenosine stress CMR in Asia has been studied by Raj et al [ 8 ] in 1,057 patients and Tsang et al [ 7 ] in 98 patients. Both studies demonstrated a very low rate (<0.5%) of adverse events during or immediately after CMR.…”

“…Patients with symptomatic heart failure, especially those with fluid retention, are at a high risk for a heart failure event during or after CMR. A study by Raj et al in India demonstrated that three patients experienced severe breathlessness during adenosine infusion and required further management, and one of them had a reduced LVEF [ 8 ]. This was consistent with our results.…”

“…Nonetheless, stress CMR continues to have a significant impact on clinical decision-making, as observed in our study. Table 4 presents a summary of patients' profiles, complications, and the clinical impact of stress CMR in our study, compared with previously published data [4][5][6][7][8]. Our data demonstrated some degree of similarity in patient profiles, such as having 28% with known CAD, consistent with Menadas et al and McGraw et al [5,6] Notably, our study had a lower proportion of male participants compared to most studies, as male patients may have a higher pretest probability of obstructive CAD and may undergo invasive coronary angiography rather than CMR.…”

“…Bruder et al also showed a very low rate of severe complications of stress CMR using adenosine and dobutamine, with a rate of 0.026% [ 4 ]. However, there are limited studies regarding the clinical impact and safety of stress CMR in Asia, and most of them were relatively small in scale [ 7 , 8 ].…”

Diagnostic value of myocardial stress detection based on feature tracking MRI in patients with acute myocardial infarction

“…The CAG to determine degree of coronary artery lesions has important value, but it has been shown that only the vascular lumen long axis of the CAG 2D images can estimate the degree of relatively narrow lumen, particularly for heart disease, making it vulnerable to the projection (22)(23)(24). The angle and the reference section of the CAG influence images of the blood vessels, and cannot provide valuable information regarding the traits of coronary artery lesions.…”