Addressing the Stress: A Fireside Chat about Program Building, Protocols, and Pitfalls in Stress CMR-Addressing the Stress: A Fireside Chat about Program Building, Protocols, and Pitfalls in Stress CMR

Video Transcription

Video Summary

This webinar from SCMR’s Pediatric Congenital Heart Disease Section focused on building and using stress cardiac MRI programs in children with congenital and coronary disease. The panel discussed why stress MRI is used, which patients benefit most, and how centers decide between dobutamine and regadenoson protocols.<br /><br />Common indications included Kawasaki disease with giant aneurysms, anomalous coronary arteries, post–arterial switch or coronary reimplantation patients, and transplant surveillance for cardiac allograft vasculopathy. The speakers emphasized that many pediatric centers reserve stress MRI for children who cannot exercise adequately or whose clinical question requires imaging beyond exercise testing, echo, or nuclear studies.<br /><br />A major theme was program development. The panel described the steep learning curve, the need for multidisciplinary buy-in from anesthesia, nursing, technologists, pharmacy, and cardiology, and the importance of simulation, internal consistency, and adult imaging mentorship. Practical barriers included formulary approval, scanner setup, infusion pump compatibility, and staffing.<br /><br />Dobutamine stress MRI was favored by some centers for wall-motion assessment and dynamic coronary obstruction, while regadenoson was used more often for vasodilatory questions and transplant surveillance. Safety was highlighted throughout: serious adverse events were rare in pediatric practice, though teams still used code carts, timeout procedures, emergency readiness, and repeated drills. The panel also discussed interpretation challenges, especially distinguishing artifacts from true perfusion defects, and the value of reviewing borderline cases with adult colleagues.<br /><br />The session closed with advice on patient age thresholds, stress targets, and the importance of experience, quality assurance, and collaboration when starting or expanding a pediatric stress MRI program.

Keywords

pediatric stress cardiac MRI

congenital heart disease

coronary artery disease

dobutamine protocol

regadenoson protocol

Kawasaki disease

anomalous coronary arteries

transplant surveillance

program development

multidisciplinary collaboration