Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, Thailand.
Division of Cardiology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
PLoS One. 2023 Oct 12;18(10):e0292950. doi: 10.1371/journal.pone.0292950. eCollection 2023.
Adenosine stress cardiac magnetic resonance (CMR) imaging is increasingly utilized for evaluating patients with known or suspected coronary artery disease (CAD). This study aims to assess the safety and clinical impact of adenosine stress CMR in a tertiary care setting in Thailand.
A total of 3,768 consecutive patients aged 18 years and above who underwent adenosine stress CMR between 2017 and 2020 were included in the study. Patient records were reviewed to collect data on clinical characteristics, hemodynamic measurements, complications during or immediately after CMR, and the rates of clinical changes resulting from CMR.
Among the included patients, the primary indications for adenosine stress CMR were risk stratification in suspected CAD (70.8%) and the assessment of myocardial ischemia/viability in patients with known CAD (26.5%). There were no reported deaths or acute myocardial infarctions during the procedure. Major complications, specifically acute pulmonary edema requiring hospital observation or admission for further management, occurred in four patients (0.11%), all of whom were elderly (ranging from 75 to 91 years) with a history of heart failure. Non-major complications were observed in 13.7% of patients, with dyspnea (9.8%) and mild chest pain (5.6%) being the most common. CMR provided a completely new diagnosis in 26.2% of patients. Overall, stress CMR resulted in a change in diagnosis or management for 48% of patients.
Adenosine stress CMR was found to be safe and to have a significant impact on clinical management in Asian patients with known or suspected CAD. These findings support the use of adenosine stress CMR as a valuable tool for evaluating and guiding treatment decisions in this patient population.
腺苷负荷心脏磁共振（CMR）成像在评估已知或疑似冠状动脉疾病（CAD）患者方面的应用日益增多。本研究旨在评估在泰国三级医疗保健环境中腺苷负荷 CMR 的安全性和临床影响。
共纳入 2017 年至 2020 年间接受腺苷负荷 CMR 的 3768 例年龄在 18 岁及以上的连续患者。回顾患者病历以收集临床特征、血流动力学测量、CMR 期间或之后即刻并发症以及 CMR 导致临床变化的发生率等数据。
在纳入的患者中，腺苷负荷 CMR 的主要适应证是疑似 CAD 的风险分层（70.8%）和已知 CAD 患者的心肌缺血/活力评估（26.5%）。在操作过程中没有报告死亡或急性心肌梗死。主要并发症，特别是需要住院观察或进一步治疗的急性肺水肿，发生在 4 例患者（0.11%）中，均为高龄（75-91 岁）且有心力衰竭病史。非主要并发症见于 13.7%的患者，最常见的是呼吸困难（9.8%）和轻度胸痛（5.6%）。CMR 为 26.2%的患者提供了全新的诊断。总体而言，负荷 CMR 导致 48%的患者的诊断或管理发生变化。
腺苷负荷 CMR 在亚洲已知或疑似 CAD 患者中是安全的，并对临床管理产生重大影响。这些发现支持将腺苷负荷 CMR 用作评估和指导该患者人群治疗决策的有价值工具。
