Abstract
The feasibility of combining low-level exercise with vasodilator stress in patients referred for stress perfusion cardiac MRI
Highlights
Adenosine, an agonist of the A2a receptor, is widely used for stress CMR
The exercise vasodilator stress CMR (EVS CMR) protocol consisted of a 1.7 mph, 0% grade treadmill walk for a total of 4 minutes; with staggered infusion of adenosine 140 mcg/kg/min starting after one minute of exercise
A comparison between both groups is found in Table 1. 9 patients successfully completed the EVS CMR protocol, with one test terminated due to bronchospasm. 10 patients successfully completed the vasodilator stress CMR (VS CMR) protocol, with one test terminated due to loss of IV access
Summary
An agonist of the A2a receptor, is widely used for stress CMR. Target receptors for adenosine are heterogeneous in their location and facilitated physiologic effects. A2b and A3 receptors are responsible for bronchospasm and peripheral arteriolar vasodilation; A1 receptors are responsible for AV block. The rate of adverse reactions with adenosine approaches 80%, consisting of dyspnea, headache, flushing, chest/ abdominal discomfort, angina, ST depression, dizziness, nausea, and dysgeusia. In SPECT protocols, use of vasodilators has been previously established as safe during low level exercise, and results in fewer adverse reactions. Our hypothesis is that adenosine administered during low level exercise treadmill stress cardiac MRI is safe, feasible, and results in diagnostic quality imaging
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