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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Feasibility and safety of high-dose adenosine perfusion cardiovascular magnetic resonance
Journal of Cardiovascular Magnetic Resonance, Volume 12, No. 1, Article 66, Year 2010
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Description
Introduction. Adenosine is the most widely used vasodilator stress agent for Cardiovascular Magnetic Resonance (CMR) perfusion studies. With the standard dose of 140 mcg/kg/min some patients fail to demonstrate characteristic haemodynamic changes: a significant increase in heart rate (HR) and mild decrease in systolic blood pressure (SBP). Whether an increase in the rate of adenosine infusion would improve peripheral and, likely, coronary vasodilatation in those patients is unknown. The aim of the present study was to assess the tolerance and safety of a high-dose adenosine protocol in patients with inadequate haemodynamic response to the standard adenosine protocol when undergoing CMR perfusion imaging. Methods. 98 consecutive patients with known or suspected coronary artery disease (CAD) underwent CMR perfusion imaging at 1.5 Tesla. Subjects were screened for contraindications to adenosine, and an electrocardiogram was performed prior to the scan. All patients initially received the standard adenosine protocol (140 mcg/kg/min for at least 3 minutes). If the haemodynamic response was inadequate (HR increase < 10 bpm or SBP decrease < 10 mmHg) then the infusion rate was increased up to a maximum of 210 mcg/kg/min (maximal infusion duration 7 minutes). Results: All patients successfully completed the CMR scan. Of a total of 98 patients, 18 (18%) did not demonstrate evidence of a significant increase in HR or decrease in SBP under the standard adenosine infusion rate. Following the increase in the rate of infusion, 16 out of those 18 patients showed an adequate haemodynamic response. One patient of the standard infusion group and two patients of the high-dose group developed transient advanced AV block. Significantly more patients complained of chest pain in the high-dose group (61% vs. 29%, p = 0.009). On multivariate analysis, age > 65 years and ejection fraction < 57% were the only independent predictors of blunted haemodynamic responsiveness to adenosine. Conclusions: A substantial number of patients do not show adequate peripheral haemodynamic response to standard-dose adenosine stress during perfusion CMR imaging. Age and reduced ejection fraction are predictors of inadequate response to standard dose adenosine. A high-dose adenosine protocol (up to 210 mcg/kg/min) is well tolerated and results in adequate haemodynamic response in nearly all patients. © 2010 Karamitsos et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Karamitsos, Theodoros D.
United Kingdom, Oxford
John Radcliffe Hospital
Ntusi, Ntobeko A.B.
United Kingdom, Oxford
John Radcliffe Hospital
Francis, Jane M.
United Kingdom, Oxford
John Radcliffe Hospital
Holloway, Cameron J.
United Kingdom, Oxford
John Radcliffe Hospital
Myerson, Saul G.
United Kingdom, Oxford
John Radcliffe Hospital
Neubauer, Stefan
United Kingdom, Oxford
John Radcliffe Hospital
Statistics
Citations: 77
Authors: 6
Affiliations: 1
Identifiers
Doi:
10.1186/1532-429X-12-66
ISSN:
1532429X
Research Areas
Health System And Policy
Noncommunicable Diseases