The safety and tolerability of adenosine as a pharmacological stressor in stress perfusion cardiac magnetic resonance imaging in the Chinese population

Tsang, Ka-Kit; Chan, Winnie S W; Shiu, C K; Chan, Michael C. W.

doi:10.12809/hkmj144437

Cited by 5 publications

(7 citation statements)

References 10 publications

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“…Sensitivity analysis involved the stepwise exclusion of individual studies from the analysis to assess their impact on the results. The pooled effects of OAC treatment on all-cause mortality were impacted by the exclusion of 2 studies [Ouellet ( 16 ) and Orkaby ( 8 )] and the effect on ischemic stroke was similarly influenced by the exclusion of 2 studies [Orkaby ( 8 ) and Subic ( 7 )]. The pooled effects of major bleeding remained unchanged with the omission of a single study.…”

Section: Resultsmentioning

confidence: 99%

“…The thermodilution-based index of microvascular resistance (T-IMR) is recommended as the gold standard for the invasive methods ( 7 ). However, T-IMR requires adenosine-induced hyperemia, which often introduces chest discomfort and dyspnea ( 8 ); the use of additional intra-vascular devices (pressure wire) increases the risk of coronary artery dissection; administering additional heparin to prevent thrombosis can also heighten the risk of hemorrhage. These limitations have restricted the widespread use of the T-IMR test.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic and prognostic value of angiography-derived index of microvascular resistance: a systematic review and meta-analysis

Wang,

Li,

Feng

et al. 2024

Front. Cardiovasc. Med.

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BackgroundThe angiography-derived index of microvascular resistance (A-IMR) is a novel tool for diagnosing coronary microvascular dysfunction (CMD) addressing limitation of unavailability. However, the clinical value of A-IMR remains controversial.MethodsA systematic review and meta-analysis was conducted. PubMed, EMBASE, Cochrane Library and Web of Science were searched for relevant studies. Studies that reported estimates of A-IMR's diagnostic accuracy (with thermodilution-based IMR as the reference test) and/or predictions of adverse cardiovascular events were selected. Pooled sensitivity, specificity, area under the summary receiver operating characteristic curve (sROC) were calculated to measure diagnostic performance; pooled hazard/risk ratio (HR/RR) and 95% confidence interval (95% CI) of major adverse cardiovascular events (MACE) or other independent adverse events were calculated to measure prognostic effect. This study was registered with PROSPERO (CRD42023451884).ResultsA total of 12 diagnostic studies pooling 1,642 vessels and 12 prognostic studies pooling 2,790 individuals were included. A-IMR yielded an area under sROC of 0.93 (95% CI: 0.91, 0.95), a pooled sensitivity of 0.85 (95% CI: 0.79, 0.89) and a pooled specificity of 0.89 (95% CI: 0.83, 0.93) for the diagnosis of CMD. CMD diagnosed using A-IMR was associated with higher risks of MACE (HR, 2.73, 95% CI: 2.16, 3.45), CV death (RR, 2.39, 95% CI: 1.49, 3.82) and heart failure hospitalization (HR, 2.30, 95% CI: 1.53, 3.45).ConclusionA-IMR demonstrated high diagnostic accuracy for CMD and showed a strong prognostic capability in predicting the risk of adverse CV outcomes.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023451884, PROSPERO (CRD42023451884).

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic and prognostic value of angiography-derived index of microvascular resistance: a systematic review and meta-analysis

Wang,

Li,

Feng

et al. 2024

Front. Cardiovasc. Med.

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“…ст.) [8,15,26]. Учет этих факторов позволяет снизить риск возникновения во время пробы клинически значимых осложнений и, соответственно, число случаев преждевременного прекращения пробы.…”

Section: противопоказания к пробе с атфunclassified

“…Для получения адекватной информации о состоянии регионального коронарного кровоснабжения во время нагрузочной пробы необходимо достижение уровня вазодилатации коронарного русла, приближающегося к максимальному [26,29,30]. Ранее было показано, что максимально возможное расширение КА при интракубитальном введении АТФ может быть получено только при введении препарата в дозе не менее 140 мкг / кг / мин, причем это состояние достигается не раньше чем через 2 мин от начала инфузии [13,21].…”

Section: начальная дозировка препаратаunclassified

Echocardiographic Stress Test with Adenosine Triphosphate: Optimization of the Algorithm

et al. 2019

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Purpose. To: 1) optimize algorithm of stress echocardiography (s-Echo) with intravenous adenosine triphosphate (ATP) infusion taking into account pharmacokinetics and pharmacodynamics of ATP in human body, 2) test new algorithm in patients with coronary and other heart diseases. Materials and methods. In order to determine spectrum of factors influencing the results of stress test with ATP we inspected main scientific data bases and found 48 publications on ATP application for diagnostic purposes. Analysis of these publications allowed us to optimize algorithm of ATP s-Echo. Optimized algorithm was tested on 26 subjects, who underwent ATP 4D strain-stress-echocardiography of the left ventricle. Results and discussion. Optimized algorithm has three stages: registration of Echo data sets before, at the time of ATP infusion, and after 5 min of ATP infusion termination. Registration of Echo parameters at the second stage must begin not earlier than 3 min after the onset of ATP infusion and only in the presence of signs of coronary vasodilation. We think that the main indirect criterion of submaximal coronary vasodilation is 5 mm Hg or more decrease in systolic blood pressure (SBP), but not below SBP level of 90 mm Hg. Initial dose of ATP is 140 µg/kg/min. If after 2 min of infusion SBP do not diminish we increase the infusion rate at first to 175 and then to 210 µg/kg/min. While testing new algorithm in all cases we have achieved criteria of effective vasodilation. Mean SBP decrease was 16.4±13.7 mm Hg, heart rate increase – 12.7±8.1 bpm. In all patients we obtained interpretable 4D LV Echo data sets for visual analysis of local contractility and automatic strain analysis. Conclusion. Optimization of ATP sEcho algorithm was performed. Safety and efficacy of optimized algorythm for registration of echo data was demonstrated. New ATP infusion algorithm can also be recommended for testing with other cardiac imaging modalities in evaluation of myocardial perfusion and contractility (SPECT, CT, MRI, PET).

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“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

Kaolawanich,

Songsangjinda,

Jirataiporn

et al. 2023

PLoS ONE

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Background Adenosine stress cardiac magnetic resonance (CMR) imaging is increasingly utilized for evaluating patients with known or suspected coronary artery disease (CAD). This study aims to assess the safety and clinical impact of adenosine stress CMR in a tertiary care setting in Thailand. Methods A total of 3,768 consecutive patients aged 18 years and above who underwent adenosine stress CMR between 2017 and 2020 were included in the study. Patient records were reviewed to collect data on clinical characteristics, hemodynamic measurements, complications during or immediately after CMR, and the rates of clinical changes resulting from CMR. Results Among the included patients, the primary indications for adenosine stress CMR were risk stratification in suspected CAD (70.8%) and the assessment of myocardial ischemia/viability in patients with known CAD (26.5%). There were no reported deaths or acute myocardial infarctions during the procedure. Major complications, specifically acute pulmonary edema requiring hospital observation or admission for further management, occurred in four patients (0.11%), all of whom were elderly (ranging from 75 to 91 years) with a history of heart failure. Non-major complications were observed in 13.7% of patients, with dyspnea (9.8%) and mild chest pain (5.6%) being the most common. CMR provided a completely new diagnosis in 26.2% of patients. Overall, stress CMR resulted in a change in diagnosis or management for 48% of patients. Conclusion Adenosine stress CMR was found to be safe and to have a significant impact on clinical management in Asian patients with known or suspected CAD. These findings support the use of adenosine stress CMR as a valuable tool for evaluating and guiding treatment decisions in this patient population.

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The safety and tolerability of adenosine as a pharmacological stressor in stress perfusion cardiac magnetic resonance imaging in the Chinese population

Cited by 5 publications

References 10 publications

Diagnostic and prognostic value of angiography-derived index of microvascular resistance: a systematic review and meta-analysis

Diagnostic and prognostic value of angiography-derived index of microvascular resistance: a systematic review and meta-analysis

Echocardiographic Stress Test with Adenosine Triphosphate: Optimization of the Algorithm

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

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