Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson

Abstract

Regadenoson might be a safe and feasible pharmacologic stress agent for use in cardiac MR in older pediatric patients with congenital heart disease and acquired heart disease. The ease of use as a bolus and the advantage of a prolonged hyperemia make its use appealing in pediatrics. In a limited number of cases, regadenoson stress perfusion showed excellent agreement with cardiac catheterization. Regadenoson might be a viable pharmacologic stress agent in this population.

A2A Adenosine Receptor Partial Agonism Related to Structural Rearrangements in an Activation Microswitch

“…The human A 2A adenosine receptor (A 2A AR) in complexes with two partial agonists, LUF5834 (Beukers et al, 2004;Lane et al, 2012) and the drug regadenoson, approved by the US Food and Drug Administration (FDA) to evaluate heart conditions (Al Jaroudi and Iskandrian, 2009;Cerqueira, 2004;Noel et al, 2017), was studied with NMR spectroscopy. NMR in solution complements crystal and cryoEM structures of GPCRs by detecting function-related structural plasticity, which may include observing multiple, simultaneously populated conformations that exist in function-related equilibria (Shimada et al, 2019).…”

Myocardial stress perfusion magnetic resonance in children with hypertrophic cardiomyopathy

“…To the best of our knowledge, this is the first description of the use of regadenoson stress cardiac MRI in paediatric hypertrophic cardiomyopathy. A recent experience with regadenoson stress perfusion cardiac MRI showed safety in the paediatric population, 8 and although they included one patient with left ventricular hypertrophy this patient did not have hypertrophic cardiomyopathy. Stress cardiac MRI in hypertrophic cardiomyopathy is commonly experienced by adults, with the majority of studies using adenosine infusion 3 …”

“…Stress first-pass imaging was qualitatively assessed and graded as "clear for diagnosis", homogeneous myocardium with no significant artefacts; "acceptable for diagnosis", the presence of dark rim artefact but without other major artefact; and "non-diagnostic", significant artefact obscuring large amount of the myocardium. 8 Simultaneous comparison was performed between the stress and rest first-pass perfusions to identify reversible versus fixed defects. The perfusion defect was considered the result of microvascular disease when no coronary territory pattern was followed.…”

“…Although multiple imaging techniques have been utilised to assess myocardial perfusion both at rest and under the effect of a pharmacologic agent, cardiovascular MRI has become increasingly popular in recent years because of it being non-invasive, with no radiation exposure and providing superior spatial resolution when compared with other modalities 7 . Stress perfusion cardiac MRI using a coronary vasodilator has been widely used in adults, but paediatric data are limited; 8 the most common experience with perfusion has been with traditional stressors, adenosine and dipyridamole. Moreover, the utility of stress perfusion cardiac MRI to detect microvascular dysfunction in the paediatric setting is unknown.…”

Recommendations for Multimodality Assessment of Congenital Coronary Anomalies: A Guide from the American Society of Echocardiography

“…Agents used include those that that cause increased myocardial oxygen demand (such as dobutamine) or increased CA blood flow (such as PersantineÒ, adenosine, or regadenoson). [16][17][18] Intravenous gadolinium-based contrast agents are typically given to enhance intravascular signal intensity, optimize CA Figure 1 Illustration (A), pathology specimen (B), and cardiac CT (C) of normal coronary origins from the aorta (Ao), demonstrating the epicardial position of the major coronary branches, including the right coronary artery (RCA), left coronary artery (LCA), left anterior descending (LAD), and circumflex (CFX) coronary arteries. PA, Pulmonary artery; SVC, superior vena cava.…”