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Multicenter Study
. 2019 Jul;29(7):3686-3695.
doi: 10.1007/s00330-019-06171-2. Epub 2019 Apr 30.

Acute adverse events in cardiac MR imaging with gadolinium-based contrast agents: results from the European Society of Cardiovascular Radiology (ESCR) MRCT Registry in 72,839 patients

Johannes Uhlig  1 , Christian Lücke  2 , Rozemarijn Vliegenthart  3 , Christian Loewe  4 , Matthias Grothoff  2 , Andreas Schuster  5 , Philipp Lurz  6 , Alexis Jacquier  7 , Marco Francone  8 , Antonia Zapf  9 , Christoph Schülke  10 ; Daniel Thomas; Matthias Stefan May  11 , Jens Bremerich  12 , Joachim Lotz  1   13 , Matthias Gutberlet  14 ; ESCR MRCT Registry contributors
Collaborators, Affiliations
Multicenter Study

Acute adverse events in cardiac MR imaging with gadolinium-based contrast agents: results from the European Society of Cardiovascular Radiology (ESCR) MRCT Registry in 72,839 patients

Johannes Uhlig et al. Eur Radiol. 2019 Jul.

Abstract

Objectives: To assess the incidence of acute adverse events (AAEs) in gadolinium-enhanced cardiac magnetic resonance (CMR) imaging.

Methods: Gadolinium-based contrast agent (GBCA)-enhanced CMR data from the multinational, multicenter European Society of Cardiovascular Radiology MRCT Registry was included. AAE severity was classified according to the American College of Radiology Manual on Contrast Media (mild, moderate, severe). Multivariable generalized linear mixed effect models were used to assess the likelihood of AAEs in various GBCA, adjusting for pharmacological stressor, main indications (i.e., suspected or known coronary artery disease or myocarditis), age, sex, and submitting center as a random effect.

Results: In the study population of 72,839 GBCA-enhanced CMRs, a total of 260 AAEs were reported (0.36%), with a minority of severe AAEs (n = 24, 0.033%). Allergic-like AAEs were less likely than physiologic AAEs (29% versus 71%). Patients without pharmacological stress imaging had a lower AAE rate (0.22%) compared to stress imaging (0.75%), with the highest AAE rates for regadenoson (2.95%). AAE rates also varied by GBCA subtype (overall p < 0.001). There was significant interaction between GBCA and pharmacological stressor (interaction p = 0.025), with AAE rates ranging between 0 and 10% for certain GBCA/stressor combinations. There was further marginal evidence that higher GBCA volume was associated with higher AAE incidence (OR = 1.02, p = 0.05).

Conclusion: GBCA-enhanced CMR imaging demonstrates low AAE rates comparable to those of other body regions. AAE likelihood correlates with GBCA subtype, pharmacological stressor, and imaging indication. Intravenous fluid administration in patients with cardiac impairment might contribute to these findings.

Key points: • Acute adverse event rates in cardiac magnetic resonance (CMR) imaging with gadolinium-based contrast agents (GBCAs) are low (0.36%), especially for severe adverse events (0.033%). • Mild and moderate adverse events are more frequent during stress CMR imaging. • Physiologic AAEs are more common than allergic AAEs in CMR imaging.

Keywords: Adverse drug event; Cardiac imaging techniques; Gadolinium; MRI.

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Conflict of interest statement

Matthias Gutberlet M.G. received modest speaker honorarium from Siemens Healthcare, Erlangen, Germany; Bayer Healthcare, Leverkusen, Germany; Philips, Amsterdam, Netherlands; and Bracco, Milan, Italy.

Figures

Fig. 1
Fig. 1
Frequency of different GBCAs used by each participating institution
See this image and copyright information in PMC

Comment in

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