{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T09:37:34Z","timestamp":1790501854904,"version":"4.1.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"1139","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BJR"],"published-print":{"date-parts":[[2022,11,1]]},"abstract":"<jats:sec><jats:title>Objectives:<\/jats:title><jats:p> Splenic switch-off (SSO) is a validated indicator of adequate vasodilator stress unique to adenosine stress cardiac MR (CMR). Patients in atrial fibrillation (AF) may have a reduced adenosine response due to lower hyperaemic coronary flow reserve and may achieve SSO less frequently versus sinus rhythm (SR). <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p> 1100 stress CMR studies were identified from a clinical CMR database (2016\u20132021). 70 patients in AF were propensity score matched to a SR group for age, sex, and body mass index. The adenosine dose administered, symptoms, heart-rate change and scan result were recorded. SSO was evaluated subjectively and semi-quantitatively via changes in splenic and myocardial signal intensity (SI) from rest to stress. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p> SSO occurred significantly less frequently in AF than SR (34\/70 [49%] vs 53\/70 [76%], p = 0.003). Semi-quantitative assessment supported this, with a smaller splenic SI difference between stress and rest in AF vs SR (median splenic stress:rest peak SI ratio 0.92 [IQR:0.61\u20131.11] vs 0.56 [IQR:0.45\u20130.75], p &lt; 0.001). A heart-rate increase &gt;10\u2009bpm predicted visual SSO in SR but not AF. Fewer patients in AF than SR had inducible ischaemia (9\/70 [13%] vs 17\/69 [25%], p = 0.058). This difference was not driven by inducible ischaemia rates in patients who did not achieve SSO (6\/36 [17%] AF vs 4\/17 [24%] SR, p = 0.403). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p> SSO occurs significantly less frequently with AF. This may risk the under diagnosis of inducible ischaemia and requires further assessment. <\/jats:p><\/jats:sec><jats:sec><jats:title>Advances in knowledge:<\/jats:title><jats:p> SSO, a validated marker of adequate stress in CMR, occurs significantly less frequently in the presence of AF, risking a suboptimal functional assessment of coronary disease. <\/jats:p><\/jats:sec>","DOI":"10.1259\/bjr.20220422","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T11:27:42Z","timestamp":1661340462000},"source":"Crossref","is-referenced-by-count":5,"title":["Assessing splenic switch-off in Adenosine stress CMR for patients with atrial fibrillation: a propensity-matched study"],"prefix":"10.1093","volume":"95","author":[{"given":"Adam","family":"Barrishi","sequence":"first","affiliation":[{"name":"Department of Radiology, Royal United Hospital, Combe Park, Bath, Avon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8753-1343","authenticated-orcid":false,"given":"John","family":"Graby","sequence":"additional","affiliation":[{"name":"Department of Radiology, Royal United Hospital, Combe Park, Bath, Avon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Khavandi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal United Hospital, Combe Park, Bath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amardeep","family":"Dastidar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, North Bristol NHS Trust, Southmead Rd, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2744-3509","authenticated-orcid":false,"given":"Jonathan CL","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Radiology, Royal United Hospital, Combe Park, Bath, Avon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"b1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz425"},{"key":"b3","first-page":"1051","volume-title":"Effect of Care Guided by Cardiovascular Magnetic Resonance, Myocardial Perfusion Scintigraphy, or NICE Guidelines on Subsequent Unnecessary Angiography Rates: The CE-MARC 2 Randomized Clinical Trial. JAMA","author":"Greenwood JP","year":"2016"},{"key":"b5","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-021-00714-7"},{"key":"b6","doi-asserted-by":"publisher","DOI":"10.1007\/s12350-020-02485-7"},{"key":"b7","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jez118.030"},{"key":"b8","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2015142059"},{"key":"b9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0024964"},{"key":"b10","doi-asserted-by":"publisher","DOI":"10.1016\/j.advms.2017.06.005"},{"key":"b11","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-015-0195-0"},{"issue":"3","key":"b12","volume":"5","author":"Kochiadakis GE","year":"2012","journal-title":"J Atr Fibrillation"},{"key":"b13","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4200"},{"key":"b14","doi-asserted-by":"publisher","DOI":"10.1007\/s00265-020-02916-y"},{"key":"b15","doi-asserted-by":"publisher","DOI":"10.1080\/00949655.2010.520163"},{"key":"b16","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2014.003"},{"key":"b17","doi-asserted-by":"publisher","DOI":"10.1093\/pan\/mpl013"},{"key":"b18","doi-asserted-by":"publisher","DOI":"10.5395\/rde.2017.42.2.152"},{"key":"b19","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-020-00696-y"},{"key":"b20","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22073467"},{"key":"b21","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq464"},{"key":"b22","doi-asserted-by":"publisher","DOI":"10.1126\/science.1373909"},{"key":"b23","doi-asserted-by":"publisher","DOI":"10.1007\/s12350-020-02448-y"},{"key":"b24","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.022931"},{"key":"b25","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.108.795328"},{"key":"b26","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeu322"},{"key":"b27","doi-asserted-by":"publisher","DOI":"10.1097\/01.anes.0000296718.35703.20"}],"container-title":["The British Journal of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.birpublications.org\/doi\/pdf\/10.1259\/bjr.20220422","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T16:44:56Z","timestamp":1705077896000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjr\/article\/7451489"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,1]]},"references-count":25,"journal-issue":{"issue":"1139","published-print":{"date-parts":[[2022,11,1]]}},"alternative-id":["10.1259\/bjr.20220422"],"URL":"https:\/\/doi.org\/10.1259\/bjr.20220422","relation":{},"ISSN":["0007-1285","1748-880X"],"issn-type":[{"value":"0007-1285","type":"print"},{"value":"1748-880X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,1]]},"article-number":"20220422"}}