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Early clinical experience with ‘splenic switch-off' in adenosine stress CMR

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Journal of Cardiovascular Magnetic Resonance201517 (Suppl 1) :P91

https://doi.org/10.1186/1532-429X-17-S1-P91

  • Published:

Keywords

  • Perfusion Imaging
  • Haemodynamic Response
  • Adenosine Stress
  • Symptomatic Response
  • Dual Response

Background

MRI Adenosine stress perfusion is a well-established method of evaluating myocardial ischaemia but we know from a number of studies that false negatives are a potential weakness of this modality. Assessment of splenic perfusion at stress and rest (splenic switch-off) has recently been suggested as a means of identifying true pharmacological stress response to adenosine[1]. This is a promising technique but can only be assessed after the stress procedure. The aim of this study was to compare symptomatic and haemodynamic response with visual assessment of splenic perfusion during stress and rest perfusion imaging to see if we could accurately predict those who would have absent splenic switch-off.

Methods

We retrospectively reviewed all patients who completed a standard adenosine perfusion CMR over 2 months at a single centre. Adenosine was administered at a standard dose of 140 μg/kg/min for at least 3 minutes prior to perfusion imaging. Adequate haemodynamic response was considered as a heartrate increase ≥ 10bpm and/or SBP decrease ≥ 10 mmHg. Appropriate symptomatic response included facial flushing, breathlessness and chest tightness. According to current clinical practice concurrent haemodynamic and symptomatic response was taken to indicate adequate physiological stress. Splenic switch-off was assessed by visual comparison between stress and rest images.

Results

145 patients attended for stress. All patients exhibited a response to adenosine. The spleen was not visible on the images of 4 patients (2.8%). Patients were divided into two categories; those who had a single response - haemodynamic or symptomatic; and those who had a dual response - both haemodynamic and symptomatic (Table 1).Splenic switch-off was visualized in one of 3 (33%) who had a haemodynamic response only and in 16 of 26 (62%) who had a symptomatic response only. Patients experiencing both a haemodynamic and symptomatic response were more likely to reflect adequate stress with splenic switch-off when compared with those experiencing a single response (p<0.001).
Table 1

Splenic switch-off related to adenosine response

 

Response to adenosine

 
 

Single

Dual

Total

Splenic switch-off

NO

Number (%)

12 (41.4%)

7 (6.3%)

19 (13.5%)

 

YES

Number (%)

17 (58.6%)

105 (93.8%)

122 (86.5%)

Total

Number (% of total)

29 (20.6%)

112 (79.4%)

141 (100%)

Conclusions

Using splenic switch-off as the gold standard assessment for adequate pharmacological response there was a good correlation with those who experienced both a haemodynamic and symptomatic response. We should consider increasing adenosine dose when patients show only a single haemodynamic or symptomatic response.

Funding

N/A.

Authors’ Affiliations

(1)
University Hospital Southampton NHS Foundation Trust, Southampton, UK

References

  1. Manisty C, Ripley D, Captur G, Peebles C, Wong T, Schelbert E, Herrey A, Greenwood J, Moon J: ‘Splenic switch-off' to detect adenosine understress; a novel method to improve test sensitivity. Journal of Cardiovascular Magnetic Resonance. 2014, 16 (Suppl 1): O1-10.1186/1532-429X-16-S1-O1.PubMed CentralView ArticleGoogle Scholar

Copyright

© Bryant et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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