Pharmacological stress cardiovascular magnetic resonance: feasibility and safety in a large multicentre prospective registry.

Abstract

To assess the feasibility and incidence of immediate complications of stress cardiovascular magnetic resonance (CMR) and to determine associated factors. This was a large multicentre, prospective registry of pharmacologic stress CMR in a referral population. We used dipyridamole when no contraindication was present and dobutamine in the remaining patients. Stress CMR was performed at 1.5 T. We recorded the clinical and demographic data, quality of test, CMR findings, haemodynamic data, and complications. Stress CMR was performed in 11 984 patients (98.2% of requested), using dipyridamole in 95.4% and dobutamine in 4.6%. The study could not be performed due to claustrophobia in 0.2%. Quality was optimal in 93.4%, suboptimal in 6.2%, and poor in 0.4% of studies. Images were diagnostic in 97.6% of patients (98.7% with dipyridamole and 75.1% with dobutamine, P < 0.0001). No patient died or had acute myocardial infarction during the test. Ten patients (0.08%) had severe immediate complications, seven after dipyridamole and two after dobutamine (P = 0.062), and one anaphylactic shock post-gadolinium. The only factor significantly associated with higher incidence of serious complications was the detection of inducible ischaemia. Incidence of non-severe complications was low (1.5%), severe controlled chest pain being the most frequent. Minor symptoms occurred frequently (24.8%). Both were significantly more frequent when dobutamine was used. Performance of stress CMR is safe in a referral population. Inducible ischaemia was the only factor identified which was associated with serious complications. The incidence of non-severe complications and minor symptoms was greater with dobutamine.