Darty, Stephen

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Stephen Darty

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ORAL PRESENTATION Open Access
Safety of adenosine stress perfusion cardiac
magnetic resonance imaging in patients
with aortic stenosis
Stephen Darty
From 2011 SCMR/Euro CMR Joint Scientific Sessions
Nice, France. 3-6 February 2011
Background
Aortic stenosis (AS) is a relative contraindication to
exercise, but the safety of adenosine stress perfusion car-
diac magnetic resonance imaging (CMR) in patients
with AS is unknown. The primary objective of this
study was to determine the safety of adenosine perfusion
CMR in patients with AS.
Methods
Consecutive patients with known or suspected coronary
artery disease (CAD) and native aortic valve stenosis
(aortic valve area [AVA] <2 cm2 by planimetry), under-
going adenosine perfusion CMR were eligible for enroll-
ment. CMR imaging included cine, first-pass perfusion
at stress and rest, and delayed-enhancement imaging.
CMR images were interpreted for CAD using an algo-
rithm previously described by our group (Klem JACC
2006;47:1630-8).
Results
112 patients with mean age 76+11 yrs (52% female) were
enrolled. Over all, 16%, 42%, and 41% has severe (AVA
<1 cm2), moderate (AVA 1-1.5 cm2), and mild (AVA
>1.5 cm2) AS. A mean dose of 31+10 mg adenosine was
infused over 2.8+0.5 minutes. There were only 2 adverse
events, both of which were transient. In the first patient
(AVA=1.0 cm2) there was a sinus pause of 3 seconds, and
the stress protocol and imaging were completed. In the
second patient (AVA=1.1 cm2), there was prolonged chest
pain with bradycardia and hypotension requiring disconti-
nuation of adenosine. Symptoms resolved within 5 min-
utes without any further intervention. In both patients, pre
and post stress ECG’s were unchanged. Diagnostic exami-
nations were completed in 111 of 112 patients. Based on
these results and using the exact method we estimate the
95% confidence intervals (CI) for the occurrence of a
severe adverse event is 0-2.6% and transient (non-severe)
event is 0.3-5.5%. Figure 1 shows an example of a positive
stress perfusion study in a patient with severe AS
(AVA=0.9 cm2). 57 of 111 patients (51%) had stress CMR
studies indicative of significant CAD.
Conclusions
Adenosine perfusion CMR is a safe alternative for non-
invasive stress testing in patients with mild to severe AS.
Figure 1
Duke Cardiovascular Magnetic Resonance Center, Durham, NC, USA
Darty Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O38
http://jcmr-online.com/content/13/S1/O38
© 2011 Darty; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-O38
Cite this article as: Darty: Safety of adenosine stress perfusion cardiac
magnetic resonance imaging in patients with aortic stenosis. Journal of
Cardiovascular Magnetic Resonance 2011 13(Suppl 1):O38.
Submit your next manuscript to BioMed Central
and take full advantage of: 
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at 
www.biomedcentral.com/submit
Darty Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O38
http://jcmr-online.com/content/13/S1/O38
Page 2 of 2


Safety of adenosine stress perfusion cardiac magnetic resonance imaging in patients with aortic stenosis

Darty Stephen

Directory of Open Access Journals

Journal of Cardiovascular Magnetic Resonance

Crossref

ORAL PRESENTATION Open AccessSafety of adenosine stress perfusion cardiacmagnetic resonance imaging in patientswith aortic stenosisStephen DartyFrom 2011 SCMR/Euro CMR Joint Scientific SessionsNice, France. 3-6 February 2011BackgroundAortic stenosis (AS) is a relative contraindication toexercise, but the safety of adenosine stress perfusion car-diac magnetic resonance imaging (CMR) in patientswith AS is unknown. The primary objective of thisstudy was to determine the safety of adenosine perfusionCMR in patients with AS.MethodsConsecutive patients with known or suspected coronaryartery disease (CAD) and native aortic valve stenosis(aortic valve area [AVA] <2 cm2 by planimetry), under-going adenosine perfusion CMR were eligible for enroll-ment. CMR imaging included cine, first-pass perfusionat stress and rest, and delayed-enhancement imaging.CMR images were interpreted for CAD using an algo-rithm previously described by our group (Klem JACC2006;47:1630-8).Results112 patients with mean age 76+11 yrs (52% female) wereenrolled. Over all, 16%, 42%, and 41% has severe (AVA<1 cm2), moderate (AVA 1-1.5 cm2), and mild (AVA>1.5 cm2) AS. A mean dose of 31+10 mg adenosine wasinfused over 2.8+0.5 minutes. There were only 2 adverseevents, both of which were transient. In the first patient(AVA=1.0 cm2) there was a sinus pause of 3 seconds, andthe stress protocol and imaging were completed. In thesecond patient (AVA=1.1 cm2), there was prolonged chestpain with bradycardia and hypotension requiring disconti-nuation of adenosine. Symptoms resolved within 5 min-utes without any further intervention. In both patients, preand post stress ECG’s were unchanged. Diagnostic exami-nations were completed in 111 of 112 patients. Based onthese results and using the exact method we estimate the95% confidence intervals (CI) for the occurrence of asevere adverse event is 0-2.6% and transient (non-severe)event is 0.3-5.5%. Figure 1 shows an example of a positivestress perfusion study in a patient with severe AS(AVA=0.9 cm2). 57 of 111 patients (51%) had stress CMRstudies indicative of significant CAD.ConclusionsAdenosine perfusion CMR is a safe alternative for non-invasive stress testing in patients with mild to severe AS.Figure 1Duke Cardiovascular Magnetic Resonance Center, Durham, NC, USADarty Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O38http://jcmr-online.com/content/13/S1/O38© 2011 Darty; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.Published: 2 February 2011doi:10.1186/1532-429X-13-S1-O38Cite this article as: Darty: Safety of adenosine stress perfusion cardiacmagnetic resonance imaging in patients with aortic stenosis. Journal ofCardiovascular Magnetic Resonance 2011 13(Suppl 1):O38.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitDarty Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O38http://jcmr-online.com/content/13/S1/O38Page 2 of 2

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Safety of adenosine stress perfusion cardiac magnetic resonance imaging in patients with aortic stenosis

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