Adenosine Triphosphate (ATP)- A Safe and Effective Vasodilator for Stress Perfusion Cardiac Magnetic Resonance

Purpose The aim of this study was to evaluate the efficiency and safety of adenosine triphosphate (ATP) as a stress agent in a cohort of patients undergoing stress perfusion cardiac magnetic resonance imaging (CMR). Methods This retrospective study was conducted between December 2019 and October 2021 at the Beijing Friendship Hospital, Beijing, China. The study included 107 subjects (age range: 53±11 years; male: female, 62%:38%) with suspected non-obstructive coronary artery disease (NOCAD) that underwent stress CMR. These patients showed typical symptoms such as chest pain (stable and unstable angina pectoris) and <50% epicardial coronary artery stenosis based on coronary angiography. Adverse effects and splenic switch‑off (SSO) phenomenon was evaluated in the patients undergoing stress CMR. Moreover, qualitative and semi-quantitative analysis of inducible ischemia was performed by using stress CMR data. Results The qualitative and semi-quantitative analysis of stress CMR data showed 82 patients with reversible myocardial ischemia. The hemodynamic response was quick and observed within 2 minutes after ATP infusion. Scanning was stopped in three patients because of atrioventricular block. CMR images of seven out of 104 patients were excluded from the final analysis because of inferior quality. During ATP infusion, 31/107 patients (29%) experienced mild adverse effects such as chest pain, flushing, dyspnea, headache, and atrioventricular block. Myocardial infarction and bronchospasms were not observed during ATP infusion. SSO, a marker of adequate stress, was observed in 91% (94/103) of the patients that underwent stress CMR. Conclusion ATP is highly effective and safe to use in stress CMR as a coronary vasodilator.The hemodynamic response is observed within 2 minutes after ATP infusion.The adverse effects during ATP infusion were mild. SSO was observed in 91% of the patients undergoing stress CMR.