Raj Vimal, Pudhiavan A, Hrishikesh V J, Ali Asik, Kothari Richa
Cardiothoracic Imaging Unit, Narayana Institute of Cardiac Sciences, Narayana Health City, Hosur Road, Bommasandra Industrial Estate, Bangalore, Karnataka, India.
Indian J Radiol Imaging. 2020 Oct-Dec;30(4):459-464. doi: 10.4103/ijri.IJRI_283_20. Epub 2021 Jan 13.
Coronary artery disease (CAD) is a major cause of morbidity and mortality in India. Stress Cardiac Magnetic Resonance (CMR) using vasodilator agent is well established in assessing the functional significance of CAD. Adenosine is the preferred agent, but can have severe side effects including dyspnoea, chest pain, atrioventricular block or bronchospasm. The stress CMR examination is not routinely performed in many of the clinical imaging departments in India.
The aim of this study was to establish safety of adenosine as a pharmacological stressor agent for CMR in a tertiary care radiology department in India.
A review of all patients undergoing stress CMR in our institution from May 2018 to May 2019 was made. Records were reviewed to collect response parameters and documented adverse reactions.
A total of 1057 patients underwent stress CMR during this period. No death, myocardial infarction or atrio-ventricular block related complications were seen. Transient hypotension was seen in 20 patients (1.8') with spontaneous recovery after stopping infusion. Chest pain and breathlessness severe enough to discontinue the scan were seen in 6 (0.5') and 10 (0.9') patients, respectively. All patients with breathlessness recovered on low flow oxygen therapy with three requiring bronchodilator. Out of six patients with chest pain, three had immediate relief with sublingual nitroglycerin, and three required hospital admission for unstable angina. Of the latter three, 1 underwent revascularization on the same day and other two later in the week.
Stress CMR using adenosine in appropriately selected patients is a highly safe procedure with significant side effects seen in less than 1' of patients. Therefore, it is safe to perform stress CMR studies in a fully equipped and well-trained radiology department in India.
冠状动脉疾病（CAD）是印度发病和死亡的主要原因。使用血管扩张剂的负荷心脏磁共振成像（CMR）在评估CAD的功能意义方面已得到充分确立。腺苷是首选药物，但可能有严重副作用，包括呼吸困难、胸痛、房室传导阻滞或支气管痉挛。在印度的许多临床影像科室，负荷CMR检查并非常规进行。
本研究的目的是在印度一家三级医疗放射科确定腺苷作为CMR药理学负荷剂的安全性。
回顾了2018年5月至2019年5月在我们机构接受负荷CMR检查的所有患者。查阅记录以收集反应参数并记录不良反应。
在此期间，共有1057例患者接受了负荷CMR检查。未观察到与死亡、心肌梗死或房室传导阻滞相关的并发症。20例患者（1.8%）出现短暂性低血压，停止输注后自行恢复。分别有6例（0.5%）和10例（0.9%）患者出现严重到足以中断扫描的胸痛和呼吸困难。所有呼吸困难患者经低流量吸氧治疗后均康复，其中3例需要使用支气管扩张剂。在6例胸痛患者中，3例舌下含服硝酸甘油后立即缓解，3例因不稳定型心绞痛需要住院治疗。后3例中，1例当天接受了血运重建，另外2例在本周晚些时候进行了血运重建。
在适当选择的患者中使用腺苷进行负荷CMR是一种高度安全的检查方法，不到1%的患者出现明显副作用。因此，在印度设备齐全且训练有素的放射科进行负荷CMR检查是安全的。
