Role of adenosine stress perfusion CMR in guiding clinical decision making in pediatric and congenital cardiology: a single pediatric center experience

Abstract

Background: Compared to adults, coronary artery disease abnormalities, significant enough to warrant viability assessment and adenosine stress perfusion cardiac magnetic resonance (CMR) imaging, are rare in pediatric patients. As a result, the role of adenosine stress perfusion CMR as a routine clinical imaging tool in these patients has not been clearly defined. We aim to evaluate the impact clinically-indicated adenosine stress perfusion CMR on decision-making and follow-up strategy. Method(s): Medical records and CMR images of all adenosine stress perfusion CMR studies performed on pediatric patients between August 2009 and May 2013 at a single institution were retrospectively reviewed. All examinations were performed on a 1.5T Siemens Avanto MRI scanner. Patients 20% was achieved. List of diagnoses and reasons for referral are reported in Table 1. 31% (8/26) of the patients had areas of inducible ischemia. Table 2 displays cardiac diagnoses, anatomical lesion on the coronary artery as proven by CMR or subsequent conventional x-ray angiography and clinical decision made after the results of the perfusion study for these patients. Two of the eight patients with areas of inducible ischemia underwent successful revascularisation, and repeat perfusion studies performed after the intervention showed no evidence of inducible ischemia. Conclusion(s): This retrospective study demonstrates that adenosine stress perfusion CMR performed in pediatric patients can positively direct clinical decision-making, Lack of ionising radiation makes this an attractive investigation with which to monitor response to revascularisation. (Table Presented).