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Comparison of hemodynamic adenosine response and splenic switch off in Indian subcontinent patients undergoing stress cardiac MRI

Session Poster session 2

Speaker Arunachalam Pudhiavan

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Stress CMR
  • Session type : Poster Session

Authors : A Pudhiavan (Bangalore,IN), VIMAL Raj (Bangalore,IN), GA Karthik (Bangalore,IN), RICHA Kothari (Bangalore,IN), DEVI Prasad Shetty (Bangalore,IN)

A Pudhiavan1 , VIMAL Raj1 , GA Karthik1 , RICHA Kothari1 , DEVI Prasad Shetty2 , 1Narayana Institute of cardiac sciences, Cardiac Radiology - Bangalore - India , 2Narayana Institute of cardiac sciences - Bangalore - India ,

Stress CMR

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii358

Introduction: The accuracy of adenosine stress CMR is undermined by concerns on the adequacy of pharmacological stress. The hemodynamic and symptomatic response to adenosine infusion along with the physiological response of splenic switch off (SSO) during stress perfusion acts as a failsafe to establish the adequacy of the pharmacological stress.

Purpose: Comparison of hemodynamic and symptomatic response to adenosine infusion to the appearance of SSO during stress perfusion CMR in Indian subcontinent patients.

Methods: This is a retrospective study of 412 consecutive patients. Adenosine was given as a slow infusion at the rate of 140 µg/kg/min. The positive response parameters were >10 beats rise in heart rate (HR), >10 mmHg diastolic or 20 mmHg systolic drop in BP and appearance of any new symptoms. The presence of SSO is estimated by semi quantitative analysis of post contrast perfusion scans for the intensity of splenic parenchyma at stress and rest and the peak myocardial signal intensity.

Results: SSO was observed in 259 patients (62.8%) and in 5 the spleen was not visualized. In patients without SSO, 111 (26.9%) patients still revealed reversible myocardial perfusion defects demonstrating adequacy of the adenosine stress response. SSO had a sensitivity of 64.6% in patients with myocardial ischemia with a positive predictive value (PPV) of 78.4% and negative predictive value (NPV) of 25%. The appearance of at least two of three hemodynamic and symptomatic response had a higher sensitivity of 88% with a PPV of 78.7% and NPV of 35.6%. The Odds ratio of hemodynamic and symptom response to SSO was 1.97 and was statistically significant (p < .001).

Conclusion: The presence of at least two of three hemodynamic and symptom response had a statistically significant association with reversible myocardial perfusion defect than SSO. In the absence of SSO, the presence of at least two of the hemodynamic and symptom response can still be considered adequate stress response without the need to repeat the study.

Sex/ Age (M:F) 350:62/ 56.2±9.9 years: 57±9.2 years
Average adenosine infusion time 3.4 minutes
Reversible myocardial ischemia 316 (77%) SSO 259 (62.8%)
Hemodynamic response HR only BP only Symptoms only HR and symptoms BP and symptoms HR, BP and symptoms HR + BP No response
26(6%) 8(2%) 12 (3%) 225 (55%) 9 (2%) 90 (22%) 29(7%) 13 (3%)
SSO present SSO absent ≥2 response <2 response
Ischemia present 203 111 278 38
Ischemia absent 56 37 75 21
HR - heart rate, BP - Blood pressure, SSO - splenic switch off

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