Background: Aortic valve stenosis (AS) has a high prevalence in elderly patients and may be associated with coronary artery disease (CAD). Dobutamine-atropine and adenosine perfusion stress cardiac magnetic resonance imaging (CMR) are well established methods to identify significant CAD. However, both modalities have relative contraindications in patients with moderate to severe AS.

Objectives: We aimed to determine the feasibility and safety of dobutamine-atropine and adenosine perfusion stress CMR in patients with moderate to severe AS.

Methods: We retrospectively studied patients with moderate to severe AS (aortic valve area ≤ 1.5 cm²) who underwent either dobutamine or adenosine stress CMR. AS was assessed using echocardiography. Patients with AS were compared to age-, gender- and BMI-matched individuals without AS, who underwent stress CMR (controls).

Results: 153 predominantly male patients (76 ± 8 years, 77% men) with moderate to severe AS were identified and compared to 153 controls. 70 patients underwent adenosine and 83 dobutamine stress CMR. Side effects occurred in 17 patients in the dobutamine group (21%). No complications or adverse events occurred in the adenosine group. During dobutamine stress CMR, 14 patients had symptomatic side effects (chest pain in 12), nausea and vomiting in 1 and dyspnea in 1, while minor complications occurred in 4 patients (paroxysmal atrial fibrillation in 2, supraventricular extrasystole in 1, and decrease of systolic blood pressure was found in 1). No major complications were reported. Three examinations were terminated prematurely because of chest pain or paroxysmal atrial fibrillation. There were no significant differences in the prevalence of side effects between patients with AS and controls. Also, we found no correlation between the degree of AS and the occurrence of complications. The Spearman´s correlation analysis revealed a weak correlation between the occurrence of complications and age (r_s = 0.318, p = 0.0034) as well as high sensitive troponin T (TnT) values (r_s = 0.307, p = 0.0096). According to multiple variable regression analyses, prior coronary artery bypass grafting, increased TnT, prior stroke/transitory ischaemic attack and age were independent predictors for the occurrence of complications.

Conclusion: Our results indicate that stress CMR is feasible and safe in patients with moderate to severe AS. We did not encounter severe adverse events, while associated symptoms occurred in dobutamine stress CMR only, with a similar prevalence as in patients without AS.