Key result
AF linked to ~71% lower odds of adequate heart rate response during adenosine stress.
Why the study?
Patients with AF are thought to have an attenuated response to adenosine during vasodilator stress testing, but its haemodynamic and hyperaemic effects in adenosine-stress CMR were unclear.
Does atrial fibrillation reduce the haemodynamic and hyperaemic effects of adenosine during cardiovascular magnetic resonance compared to sinus rhythm?
Cohort (n=318)
No
Does atrial fibrillation reduce the haemodynamic and hyperaemic effects of adenosine during cardiovascular magnetic resonance compared to sinus rhythm?
Odds Ratio: 0.29 (95% CI 0.17–0.5)
Absolute Event Rate: 40% vs 76%
p-value: p=<0.001
Although the traditional heart rate response is blunted in atrial fibrillation during adenosine stress CMR, most patients still generate an adequate hyperaemic response, validating the test's utility in this population.
AF blunts adenosine heart rate response in stress CMR without impairing hyperemia; leaves open whether thresholds need adjustment in prospective validation.
Aims Patients with atrial fibrillation (AF) are thought to have an attenuated response to adenosine during vasodilator stress testing. We sought to investigate the haemodynamic and hyperaemic effects of adenosine in patients with AF undergoing adenosine-stress cardiovascular magnetic resonance (CMR) assessment. Methods and results We retrospectively examined 318 patients referred for clinical adenosine-stress CMR (AF n = 158, sinus rhythm [SR] n = 160). Baseline and peak heart rate (HR) and quantitative myocardial perfusion were compared between groups. At peak stress, the haemodynamic response was blunted in patients with AF (HR increase 7 ± 10bpm vs. 17 ± 11bpm in SR, P < 0.001). Fewer patients in AF met the threshold for a satisfactory HR response ≥10bpm (40% in AF vs. 76% in SR, P < 0.001). There were no intergroup differences in hyperaemic myocardial blood flow (1.52 ± 0.65 mL/min/g in AF vs. 1.55 ± 0.65 mL/min/g in SR, P = 0.670) or myocardial perfusion reserve (2.66 ± 1.11 in AF vs. 2.66 ± 1.08 in SR, P = 0.981). AF (odds ratio [OR], 0.29 [0.17–0.50], P < 0.001) and left ventricular ejection fraction (OR 1.03 [1.00–1.05], P = 0.023) were independently associated with achieving a satisfactory HR response on multivariable analysis, but only ejection fraction (OR 1.05 [1.02–1.09], P = 0.003) predicted a satisfactory hyperaemic response. Conclusion The heart rate response during adenosine-stress CMR is blunted in AF patients. Despite this, the majority of patients with AF generate a sufficient hyperaemic response with a standard adenosine-stress protocol. Further work is needed to determine the diagnostic accuracy of adenosine-stress CMR in patients with AF.
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Shergill et al. (2024) conducted a cohort in Known or suspected coronary artery disease undergoing adenosine-stress CMR (n=318). Atrial fibrillation vs. Sinus rhythm was evaluated on Satisfactory heart rate response (≥10 bpm increase) at peak adenosine stress (OR 0.29, 95% CI 0.17-0.50, p=<0.001). Atrial fibrillation was independently associated with a significantly reduced odds of achieving a satisfactory heart rate response during adenosine stress compared to sinus rhythm (OR 0.29, p<0.001).
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