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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
The adverse events and hemodynamic effects of adenosine-based cardiac MRI
Thomas Voigtländer1, Axel Schmermund, Peter Bramlage
1Cardiovascular Center Bethanien, Frankfurt/Main, Germany. t.voigtlaender@ccb.de
Objective:
We wanted to prospectively assess the adverse events and hemodynamic effects associated with an intravenous adenosine infusion in patients with suspected or known coronary artery disease and who were undergoing cardiac MRI.
Materials And Methods:
One hundred and sixty-eight patients (64 ± 9 years) received adenosine (140 µg/kg/min) during cardiac MRI. Before and during the administration, the heart rate, systemic blood pressure, and oxygen saturation were monitored using a MRI-compatible system. We documented any signs and symptoms of potential adverse events.
Results:
In total, 47 out of 168 patients (28%) experienced adverse effects, which were mostly mild or moderate. In 13 patients (8%), the adenosine infusion was discontinued due to intolerable dyspnea or chest pain. No high grade atrioventricular block, bronchospasm or other life-threatening adverse events occurred. The hemodynamic measurements showed a significant increase in the heart rate during adenosine infusion (69.3 ± 11.7 versus 82.4 ± 13.0 beats/min, respectively; p < 0.001). A significant but clinically irrelevant increase in oxygen saturation occurred during adenosine infusion (96 ± 1.9% versus 97 ± 1.3%, respectively; p < 0.001). The blood pressure did not significantly change during adenosine infusion (systolic: 142.8 ± 24.0 versus 140.9 ± 25.7 mmHg; diastolic: 80.2 ± 12.5 mmHg versus 78.9 ± 15.6, respectively).
Conclusion:
This study confirms the safety of adenosine infusion during cardiac MRI. A considerable proportion of all patients will experience minor adverse effects and some patients will not tolerate adenosine infusion. However, all adverse events can be successfully managed by a radiologist. The increased heart rate during adenosine infusion highlights the need to individually adjust the settings according to the patient, e.g., the number of slices of myocardial perfusion imaging.
Insights
Intravenous adenosine infusion during cardiac MRI is safe, with most adverse events being mild. While some patients may not tolerate the infusion, radiologists can manage these effects effectively.
Area of Science:
- Cardiovascular Imaging
- Pharmacology
- Radiology
Background:
- Cardiac MRI is a valuable tool for diagnosing coronary artery disease.
- Adenosine is a vasodilator used to assess myocardial perfusion during cardiac MRI.
- Understanding the safety profile of adenosine infusion is crucial for its clinical application.
Purpose of the Study:
- To prospectively evaluate adverse events and hemodynamic changes during intravenous adenosine infusion in patients undergoing cardiac MRI.
- To assess the safety and tolerability of adenosine in this patient population.
Main Methods:
- 168 patients with suspected or known coronary artery disease received adenosine (140 µg/kg/min) during cardiac MRI.
- Heart rate, blood pressure, and oxygen saturation were monitored continuously.
- Adverse events and patient symptoms were systematically documented.
Main Results:
- 28% of patients experienced mild to moderate adverse effects; 8% discontinued due to dyspnea or chest pain.
- No life-threatening events like high-grade atrioventricular block or bronchospasm occurred.
- Heart rate significantly increased, while blood pressure and oxygen saturation remained largely unchanged.
Conclusions:
- Adenosine infusion is confirmed as safe for cardiac MRI.
- Minor adverse effects are common, and some patients may not tolerate the infusion, but these are manageable by radiologists.
- The observed increase in heart rate necessitates individualized MRI protocol adjustments.
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Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...