title: Stress cardiovascular MR in routine clinical practice: referral patterns, accuracy, tolerance, safety and incidental findings.
abstract: OBJECTIVE
  The use of stress cardiovascular MR (CMR) to evaluate myocardial ischaemia has increased significantly over recent years. We aimed to assess the indications, incidental findings, tolerance, safety and accuracy of stress CMR in routine clinical practice.
  
  
  METHODS
  We retrospectively examined all stress CMR studies performed at our tertiary referral centre over a 20-month period. Patients were scanned at 1.5 T, using a standardised protocol with routine imaging for late gadolinium enhancement. Angiograms of patients were assessed by an interventional cardiologist blinded to the CMR data.
  
  
  RESULTS
  654 patients were scanned (mean age 65±29 years; 63 inpatients; 9.6%). 14% of patients had incidental extracardiac findings, the commonest being liver or renal cysts (6%) and pulmonary nodules (4%). 639 patients (97.7%) received intravenous adenosine, 10 received intravenous dobutamine and 5 patients had both. Of the 15 patients who received dobutamine, 12 had no side-effects/complications, 2 experienced nausea and 1 chest tightness. Of the 644 patients who received adenosine, 43% experienced minor symptoms, 1% had transient heart block and 0.2% had severe bronchospasm requiring termination of infusion. There were no cases of hospitalisation or myocardial infarction. 241 patients also had coronary angiography. For detecting at least moderate stenosis of ≥50%, sensitivity was 86%, specificity 98% and accuracy 89%. For detecting severe stenoses of ≥70%, sensitivity was 91%, specificity 86% and overall accuracy 90%. These results compare very favourably with previous smaller research studies and meta-analyses.
  
  
  CONCLUSIONS
  We conclude that stress CMR, with adenosine as the main stress agent, is well tolerated, safe and accurate in routine clinical practice.
authors.affiliation: Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Khoo
authors.forename: B J
authors.initials: BJ
authors.lastname: Grundy
authors.forename: C D
authors.initials: CD
authors.lastname: Steadman
authors.forename: E P
authors.initials: EP
authors.lastname: Sonnex
authors.forename: R A
authors.initials: RA
authors.lastname: Coulden
authors.forename: G P
authors.initials: GP
authors.lastname: McCann
mesh_terms: D000241:Adenosine / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002037:Bundle-Branch Block / Q000209:etiology; D009202:Cardiomyopathies / Q000175:diagnosis; D002316:Cardiotonic Agents; D002637:Chest Pain / Q000209:etiology; D002908:Chronic Disease; D003287:Contrast Media; D023921:Coronary Stenosis / Q000175:diagnosis*; D003560:Cysts / Q000175:diagnosis; D004280:Dobutamine; D005080:Exercise Test; D019786:Gadolinium DTPA; D006338:Heart Neoplasms / Q000175:diagnosis; D006349:Heart Valve Diseases / Q000175:diagnosis; D006801:Humans; D033162:Incidental Findings; D008067:Lipoma / Q000175:diagnosis; D008107:Liver Diseases / Q000175:diagnosis; D018810:Magnetic Resonance Angiography / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000175:diagnosis; D012372:ROC Curve; D012017:Referral and Consultation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000175:diagnosis; D014665:Vasodilator Agents / Q000009:adverse effects; D018487:Ventricular Dysfunction, Left / Q000209:etiology
chemical_list: D002316:Cardiotonic Agents; D003287:Contrast Media; D014665:Vasodilator Agents; D004280:Dobutamine; D019786:Gadolinium DTPA; D000241:Adenosine