Korean J Radiol.  2011 Aug;12(4):424-430. 10.3348/kjr.2011.12.4.424.

The Adverse Events and Hemodynamic Effects of Adenosine-Based Cardiac MRI

• Voigtlander T
• Schmermund A
• Bramlage P
• Elsasser A
• Magedanz A
• Kauczor HU
• Mohrs OK

• KMID: 1783208
• DOI: http://doi.org/10.3348/kjr.2011.12.4.424

Abstract

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 microg/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.

Keyword

MRI; Adenosine; Coronary artery disease; Hemodynamics; Adverse events

MeSH Terms

Adenosine/administration & dosage/*adverse effects
Adult
Aged
Aged, 80 and over
Blood Pressure/drug effects
Contrast Media/diagnostic use
Coronary Disease/*diagnosis
Female
Gadolinium DTPA/diagnostic use
Heart Rate/drug effects
Hemodynamics
Humans
Infusions, Intravenous
*Magnetic Resonance Imaging
Male
Middle Aged
Oxygen/blood
Prospective Studies
Vasodilator Agents/administration & dosage/*adverse effects

Figure

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  Fig. 1 Typical example of adenosine-based detection of coronary artery disease using myocardial perfusion cardiovascular MRI. A. Invasive coronary angiography of 71-year-old female reveals high-grade right coronary arterial stenosis (arrow). B. Perfusion deficit in inferior wall (arrows) is documented using short axis view of cardiovascular MRI-based perfusion imaging during adenosine infusion.

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  Fig. 2 Usefulness of adenosine-based phase-contrast flow imaging in 68-year-old man. A. Maximum intensity projection of contrast-enhanced MR angiography shows patient with patent left internal thoracic artery bypass graft (arrows) to left anterior descending coronary artery. B, C. Using adenosine-based phase-contrast flow MR imaging (B, magnitude image; C, phase image) (arrows), high-grade stenosis of coronary bypass graft could be detected by quantification of insufficient flow reserve in comparison to flow measurement with patient at rest.

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  Fig. 3 Boxplot diagrams of diastolic (A) and systolic (B) blood pressure demonstrating no significant change before and during adenosine infusion.

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  Fig. 4 Boxplot diagram shows small, but significant increase of blood oxygen saturation during adenosine infusion. This is advantageous in contrast to dobutamine, which increases myocardial oxygen consumption due to its positive inotropic effects.

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  Fig. 5 Boxplot diagram demonstrates significant decrease of length of cardiac cycle during adenosine infusion. Therefore, it could be mandatory to plan to potentially tailor examination (e.g., reduced number of slices of myocardial perfusion imaging) in advance.

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