A comparison of standard and high dose adenosine protocols in routine vasodilator stress cardiovascular magnetic resonance: dosage affects hyperaemic myocardial blood flow in patients with severe left ventricular systolic impairment

Journal of Cardiovascular Magnetic Resonance

Thomas Craven¹  Louise A. E. Brown¹  Peter P. Swoboda¹  Eylem Levelt¹  Sven Plein¹  Erica Dall’Armellina¹  Arka Das¹  Christopher E. D. Saunderson¹  John P. Greenwood¹  Peter Kellman²  Hui Xue³  James C. Moon⁴  Kristopher D. Knott⁴ 

[1] Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, LS2 9JT, Leeds, UK;Multidisciplinary Cardiovascular Research Centre (MCRC) & Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, LS2 9JT, Leeds, UK;The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK;National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA;National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA;The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London, UK;National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, MD, USA;

关键词: Perfusion;    Myocardial blood flow;    Adenosine stress;    Heart failure;   

DOI  :  10.1186/s12968-021-00714-7

来源: Springer

【 摘 要 】

BackgroundAdenosine stress perfusion cardiovascular magnetic resonance (CMR) is commonly used in the assessment of patients with suspected ischaemia. Accepted protocols recommend administration of adenosine at a dose of 140 µg/kg/min increased up to 210 µg/kg/min if required. Conventionally, adequate stress has been assessed using change in heart rate, however, recent studies have suggested that these peripheral measurements may not reflect hyperaemia and can be blunted, in particular, in patients with heart failure. This study looked to compare stress myocardial blood flow (MBF) and haemodynamic response with different dosing regimens of adenosine during stress perfusion CMR in patients and healthy controls.Methods20 healthy adult subjects were recruited as controls to compare 3 adenosine perfusion protocols: standard dose (140 µg/kg/min for 4 min), high dose (210 µg/kg/min for 4 min) and long dose (140 µg/kg/min for 8 min). 60 patients with either known or suspected coronary artery disease (CAD) or with heart failure and different degrees of left ventricular (LV) dysfunction underwent adenosine stress with standard and high dose adenosine within the same scan. All studies were carried out on a 3 T CMR scanner. Quantitative global myocardial perfusion and haemodynamic response were compared between doses.ResultsIn healthy controls, no significant difference was seen in stress MBF between the 3 protocols. In patients with known or suspected CAD, and those with heart failure and mild systolic impairment (LV ejection fraction (LVEF) ≥ 40%) no significant difference was seen in stress MBF between standard and high dose adenosine. In those with LVEF < 40%, there was a significantly higher stress MBF following high dose adenosine compared to standard dose (1.33 ± 0.46 vs 1.10 ± 0.47 ml/g/min, p = 0.004). Non-responders to standard dose adenosine (defined by an increase in heart rate (HR) < 10 bpm) had a significantly higher stress HR following high dose (75 ± 12 vs 70 ± 14 bpm, p = 0.034), but showed no significant difference in stress MBF.ConclusionsIncreasing adenosine dose from 140 to 210 µg/kg/min leads to increased stress MBF in patients with significantly impaired LV systolic function. Adenosine dose in clinical perfusion assessment may need to be increased in these patients.

【 授权许可】

CC BY