INTRODUCTION: Vasodilator stress cardiovascular magnetic resonance (CMR) is a powerful diagnostic modality, but data toward its use in patients with permanent pacemakers (PPMs) or implantable cardioverter-defibrillators (ICDs) is limited. METHODS AND RESULTS: Patients with ICDs (>1% pacing) or PPMs who underwent regadenoson single photon emission computed tomography (SPECT) and all patients with ICDs or PPMs who underwent stress CMR were retrospectively identified. SPECT tests were analyzed for hemodynamic responses and new pacing requirements; CMR studies were examined for safety, device characteristics and programming, hemodynamic responses, and image quality. Changes from baseline were evaluated with the Related-Samples Wilcoxon Signed Rank Test. Of 67 patients (median age 65 [IQR 58-72] years, 31 [46%] female, 31 [46%] Black), 47 underwent SPECT and 20 CMR. With regadenoson SPECT, 89% of patients experienced tachycardic responses above resting heart rates (+19 [13-32] beats per minute, p < .01). During stress CMR, 10 (50%) devices were asynchronously paced approximately 10 beats per minute above resting rates, and the remaining were temporarily deactivated. Those with asynchronous pacing had no changes in heart rates, whereas patients with deactivated devices had near uniform heart rate accelerations. Image quality was diagnostic in the majority of stress CMR sequences, with nonconditional ICDs contributing 40 of 57 (70%) of nondiagnostic segments. CONCLUSION: This data supports the safety of vasodilator stress CMR with promising diagnostic quality images in patients with CMR conditional ICDs and PPMs. Despite a near uniform tachycardic response to regadenoson in the SPECT environment, high rates of asynchronous pacing during vasodilator stress CMR did not result in competitive pacing or adverse arrhythmic events. Further studies are needed to validate these findings and confirm the diagnostic and prognostic performance of stress CMR in these individuals.
INTRODUCTION: Vasodilator stress cardiovascular magnetic resonance (CMR) is a powerful diagnostic modality, but data toward its use in patients with permanent pacemakers (PPMs) or implantable cardioverter-defibrillators (ICDs) is limited. METHODS AND RESULTS: Patients with ICDs (>1% pacing) or PPMs who underwent regadenoson single photon emission computed tomography (SPECT) and all patients with ICDs or PPMs who underwent stress CMR were retrospectively identified. SPECT tests were analyzed for hemodynamic responses and new pacing requirements; CMR studies were examined for safety, device characteristics and programming, hemodynamic responses, and image quality. Changes from baseline were evaluated with the Related-Samples Wilcoxon Signed Rank Test. Of 67 patients (median age 65 [IQR 58-72] years, 31 [46%] female, 31 [46%] Black), 47 underwent SPECT and 20 CMR. With regadenoson SPECT, 89% of patients experienced tachycardic responses above resting heart rates (+19 [13-32] beats per minute, p < .01). During stress CMR, 10 (50%) devices were asynchronously paced approximately 10 beats per minute above resting rates, and the remaining were temporarily deactivated. Those with asynchronous pacing had no changes in heart rates, whereas patients with deactivated devices had near uniform heart rate accelerations. Image quality was diagnostic in the majority of stress CMR sequences, with nonconditional ICDs contributing 40 of 57 (70%) of nondiagnostic segments. CONCLUSION: This data supports the safety of vasodilator stress CMR with promising diagnostic quality images in patients with CMR conditional ICDs and PPMs. Despite a near uniform tachycardic response to regadenoson in the SPECT environment, high rates of asynchronous pacing during vasodilator stress CMR did not result in competitive pacing or adverse arrhythmic events. Further studies are needed to validate these findings and confirm the diagnostic and prognostic performance of stress CMR in these individuals.
Authors: KyungPyo Hong; Jeremy D Collins; Benjamin H Freed; Lexiaozi Fan; Andrew E Arai; Li-Yueh Hsu; Daniel C Lee; Daniel Kim Journal: Radiol Cardiothorac Imaging Date: 2020-04-16
Authors: John P Greenwood; Neil Maredia; John F Younger; Julia M Brown; Jane Nixon; Colin C Everett; Petra Bijsterveld; John P Ridgway; Aleksandra Radjenovic; Catherine J Dickinson; Stephen G Ball; Sven Plein Journal: Lancet Date: 2011-12-22 Impact factor: 79.321
Authors: Louise A E Brown; Christopher E D Saunderson; Arka Das; Thomas Craven; Eylem Levelt; Kristopher D Knott; Erica Dall'Armellina; Hui Xue; James C Moon; John P Greenwood; Peter Kellman; Peter P Swoboda; Sven Plein Journal: J Cardiovasc Magn Reson Date: 2021-03-18 Impact factor: 5.364
Authors: Raymond Y Kwong; Yin Ge; Kevin Steel; Scott Bingham; Shuaib Abdullah; Kana Fujikura; Wei Wang; Ankur Pandya; Yi-Yun Chen; J Ronald Mikolich; Sebastian Boland; Andrew E Arai; W Patricia Bandettini; Sujata M Shanbhag; Amit R Patel; Akhil Narang; Afshin Farzaneh-Far; Benjamin Romer; John F Heitner; Jean Y Ho; Jaspal Singh; Chetan Shenoy; Andrew Hughes; Steve W Leung; Meera Marji; Jorge A Gonzalez; Sandeep Mehta; Dipan J Shah; Dany Debs; Subha V Raman; Avirup Guha; Victor A Ferrari; Jeanette Schulz-Menger; Rory Hachamovitch; Matthias Stuber; Orlando P Simonetti Journal: J Am Coll Cardiol Date: 2019-10-08 Impact factor: 24.094