Gadolinium-based Contrast Agents for Cardiac MRI: Use of Linear and Macrocyclic Agents with Associated Safety Profile from 154 779 European Patients.

Purpose: To assess current use and acute safety profiles of gadolinium-based contrast agents (GBCAs) in cardiac MRI given recent suspensions of GBCA approval.

Materials And Methods: Patients were retrospectively included from the multinational multicenter European Society of Cardiovascular Radiology (ESCR) MR/CT Registry collected between January 2013 and October 2019. GBCA-associated acute adverse events (AAEs) were classified as mild (self-limiting), moderate (pronounced AAE requiring medical management), and severe (life threatening). Multivariable generalized linear mixed-effect models were used to assess AAE likelihood.

Results: A total of 154 779 patients (average age, 53 years ± 19 [standard deviation]; 99 106 men) who underwent cardiac MRI were included, the majority of whom underwent administration of GBCAs (94.2% [ = 145 855]). While linear GBCAs were used in 15.2% of examinations through 2011, their use decreased to less than 1% in 2018 and 2019. Overall, 0.36% ( = 556) of AAEs were documented (mild, 0.12% [ = 178]; moderate, 0.21% [ = 331]; severe, 0.03% [ = 47]). For nonenhanced cardiac MRI, examination-related events were reported in 2.59% (231 of 8924) of cases, the majority of which were anxiety (0.98% [ = 87]) and dyspnea (0.93% [ = 83]). AAE rates varied significantly by pharmacologic stressor, GBCA molecular structure (macrocyclic vs linear GBCA: multivariable odds ratio, 0.634; 95% confidence interval: 0.452, 0.888; = .008), GBCA subtype, and imaging indication.

Conclusion: Gadolinium-based contrast agent administration changed according to recent regulatory decisions, with use of macrocyclic agents almost exclusively in 2018 and 2019; these agents also demonstrated a favorable acute safety profile.© RSNA, 2020.