Francis, Jane M

Holloway, Cameron J

Karamitsos, Theodoros D

Myerson, Saul G

Neubauer, Stefan

Ntusi, Ntobeko BA

English

PubMed

Theodoros D Karamitsos

Ntobeko BA Ntusi

Jane M Francis

Cameron J Holloway

Saul G Myerson

Stefan Neubauer

Springer - Publisher Connector

Feasibility and safety of high-dose adenosine perfusion cardiovascular magnetic resonance imaging

Myerson Saul G

Holloway Cameron J

Francis Jane M

Ntusi Ntobeko BA

Karamitsos Theodoros D

Neubauer Stefan

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Journal of Cardiovascular Magnetic Resonance

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POSTER PRESENTATION Open Access
Feasibility and safety of high-dose adenosine
perfusion cardiovascular magnetic resonance
imaging
Theodoros D Karamitsos*, Ntobeko BA Ntusi, Jane M Francis, Cameron J Holloway, Saul G Myerson,
Stefan Neubauer
From 2011 SCMR/Euro CMR Joint Scientific Sessions
Nice, France. 3-6 February 2011
Objective
The aim of the present study was to assess the tolerance
and safety of a high-dose adenosine protocol (210mcg/
kg/min) in patients with inadequate hemodynamic
response to the standard adenosine dose (140mcg/kg/
min) when undergoing CMR perfusion imaging.
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
hemodynamic 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.
Methods
98 consecutive patients with known or suspected coron-
ary artery disease (CAD) underwent CMR perfusion
imaging at 1.5 Tesla. Subjects were screened for contra-
indications 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 hemodynamic
response was inadequate (HR increase <10bpm or SBP
decrease <10mmHg) then the infusion rate was
increased up to a maximum of 210 mcg/kg/min (maxi-
mal infusion duration 7 minutes).
Results
All patients successfully completed the CMR scan. Of a
total of 98 patients, 18 (18%) did not demonstrate evi-
dence 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 hemodynamic response.
The hemodynamic parameters at rest and during adeno-
sine stress are shown on table 2. Two patients of the
standard infusion group and one patient of the high-
dose group developed transient advanced AV block. Sig-
nificantly more patients complained of chest pain in the
high-dose group (61% vs. 29%, p= 0.009) .On multivari-
ate analysis, age > 65 years and ejection fraction <57%
were the only independent predictors of blunted haemo-
dynamic responsiveness to adenosine.
Oxford Centre for Clinical Magnetic Resonance Research, OXFORD, UK
Full list of author information is available at the end of the article
Table 1 Hemodynamic Parameters at Rest and During
Adenosine Stress
Standard dose Adenosine
(n=80)
High dose Adenosine (n= 18)
Rest Peak p-value Rest 140μg/
kg/min
Peak p-value
HR
(bpm)
70±13 96±16 <0.001 66±12 75±11 81
±18*
0.011
SBP
(mmHg)
137
±18
139
±19
0.21 139
±23
134±24 132
±22
0.68
DBP
(mmHg)
80±12 81±12 0.55 82±12 79±11 77±14 0.57
RPP 9639
±2399
13304
±2781
<0.001 8975
±1909
9945
±1694
10672
±2787
0.07
* p<0.05 vs. rest.
DBP, diastolic blood pressure; HR, heart rate; RPP, rate pressure product; SBP,
systolic blood pressure.
Karamitsos et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P105
http://jcmr-online.com/content/13/S1/P105
© 2011 Karamitsos et al; 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.
Conclusions
A substantial number of patients do not show adequate
peripheral hemodynamic response to standard-dose ade-
nosine stress during perfusion CMR imaging. Age and
reduced ejection fraction are predictors of inadequate
response to standard dose adenosine. Our initial experi-
ence with a high-dose adenosine protocol (up to 210
mcg/kg/min) shows that it is well tolerated and results
in adequate hemodynamic response in nearly all
patients.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-P105
Cite this article as: Karamitsos et al.: Feasibility and safety of high-dose
adenosine perfusion cardiovascular magnetic resonance imaging.
Journal of Cardiovascular Magnetic Resonance 2011 13(Suppl 1):P105.
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Karamitsos et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P105
http://jcmr-online.com/content/13/S1/P105
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Feasibility and safety of high-dose adenosine perfusion cardiovascular magnetic resonance imaging

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