ORIGINAL PAPER Tolerance and safety of adenosine stress perfusion cardiovascular magnetic resonance imaging in patients with severe coronary artery disease Theodoros D. Karamitsos Æ Jayanth R. Arnold Æ Tammy J. Pegg Æ Adrian S. H. Cheng Æ William J. van Gaal Æ Jane M. Francis Æ Adrian P. Banning Æ Stefan Neubauer Æ Joseph B. Selvanayagam Received: 15 August 2008 / Accepted: 10 November 2008 / Published online: 27 November 2008 Ó Springer Science+Business Media, B.V. 2008 Abstract We sought to assess the tolerance and safety of adenosine-stress cardiovascular magnetic resonance (CMR) perfusion imaging in patients with coronary artery disease (CAD). We retrospectively examined all adenosine CMR perfusion scans per- formed in our centre in patients with known or suspected (CAD) and normal volunteers at either 1.5 or 3 T. All subjects were initially screened for contraindications to adenosine. The dose of adeno- sine infused was 140 lg/kg/min. Significant CAD was defined angiographically as the presence of at least one stenosis of [ 50% diameter. Data were collected from 351 consecutive subjects (mean age 62 ± 11 years, range 25–85 years-245 men). Of the 351 subjects, 305 had a coronary angiogram, the remaining 46 subjects were normal volunteers studied for research protocols. In total, 233 subjects (76%) were found to have significant CAD of whom 128 had multi-vessel disease. There were no deaths, myocardial infarctions, or episodes of bronchospasm during the CMR study. Transient 2nd (Mobitz II) or 3rd-degree atrioventricular (AV) block occurred in 27 patients (8%). There were no sustained episodes of advanced AV block. Transient chest pain was the most common side effect (199 subjects—57%). The use of intravenous adenosine in CMR perfusion imaging is safe and well-tolerated, even in patients with severe CAD. Where a careful screening policy for contraindications to adenosine is followed, seri- ous adverse events in the CMR scanner are relatively rare and symptoms resolve following termination of the infusion, without the need for aminophylline. Keywords Adenosine Á Perfusion Á Cardiac magnetic resonance Á Coronary artery disease Á Safety Introduction Myocardial perfusion imaging involves stressing the heart with either physiological exercise or a pharma- cological agent, which is usually a vasodilator such as adenosine or dipyridamole. These agents produce near-maximal vasodilatation in normal coronary arteries, resulting in an increment in coronary blood flow four to five times above normal. In myocardial segments supplied by a stenotic epicardial vessel resistance in the arteriolar level is already reduced in the resting state in order to maintain regional myocardial blood flow (i.e., coronary vasodilator T. D. Karamitsos (&) Á J. R. Arnold Á T. J. Pegg Á A. S. H. Cheng Á J. M. Francis Á S. Neubauer Á J. B. Selvanayagam Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, John Radcliffe Hospital, University of Oxford, OX3 9DU Oxford, UK e-mail: theo.karamitsos@cardiov.ox.ac.uk W. J. van Gaal Á A. P. Banning Department of Cardiology, John Radcliffe Hospital, Oxford, UK 123 Int J Cardiovasc Imaging (2009) 25:277–283 DOI 10.1007/s10554-008-9392-3