Regadenoson cardiovascular magnetic resonance myocardial perfusion imaging predicts need for future revascularization

Freed, Benjamin H.; Turner, Kristen M.; Yodwut, Chattanong; Tarroni, Giacomo; Estep, Emily; Bhave, Nicole M.; Narang, Akhil; S, Tanaka; Corsi, Cristiana; Gayat, Étienne; Czobor, Peter; Cavanaugh, Kevin; Lang, Roberto M.; Mor‐Avi, Victor; Patel, Amit R.

doi:10.1186/1532-429x-14-s1-p7

Cited by 2 publications

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“…Regadenoson, a selective A 2A receptor agonist, is an appealing alternative for stress CMR because it is administered as a single, standard-dose bolus (such that only one IV line is required) and has a more favorable side-effect profile [15,16]. We have demonstrated the feasibility and safety of regadenoson CMR and have shown that perfusion defects on stress CMR images predict future need for revascularization [17]. One advantage of stress CMR is the ability to quantify myocardial perfusion reserve (MPR), which is less dependent upon interpreter expertise and improves the accuracy of the detection of multivessel coronary artery disease [18].…”

Section: Introductionmentioning

confidence: 99%

“…After administration, it redistributes rapidly throughout the body, followed by slower elimination. Due to regadenoson’s longer half-life, recovery is occasionally facilitated with aminophylline before resting images are acquired [17,23]. However, the residual impact of regadenoson on coronary blood flow during the clearance period is not known.…”

Section: Introductionmentioning

confidence: 99%

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Considerations when measuring myocardial perfusion reserve by cardiovascular magnetic resonance using regadenoson

Bhave

Freed

Yodwut

et al. 2012

Journal of Cardiovascular Magnetic Resonance

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BackgroundAdenosine cardiovascular magnetic resonance (CMR) can accurately quantify myocardial perfusion reserve. While regadenoson is increasingly employed due to ease of use, imaging protocols have not been standardized. We sought to determine the optimal regadenoson CMR protocol for quantifying myocardial perfusion reserve index (MPRi) – more specifically, whether regadenoson stress imaging should be performed before or after rest imaging.MethodsTwenty healthy subjects underwent CMR perfusion imaging during resting conditions, during regadenoson-induced hyperemia (0.4 mg), and after 15 min of recovery. In 10/20 subjects, recovery was facilitated with aminophylline (125 mg). Myocardial time-intensity curves were used to obtain left ventricular cavity-normalized myocardial up-slopes. MPRi was calculated in two different ways: as the up-slope ratio of stress to rest (MPRi-rest), and the up-slope ratio of stress to recovery (MPRi-recov).ResultsIn all 20 subjects, MPRi-rest was 1.78 ± 0.60. Recovery up-slope did not return to resting levels, regardless of aminophylline use. Among patients not receiving aminophylline, MPRi-recov was 36 ± 16% lower than MPRi-rest (1.13 ± 0.38 vs. 1.82 ± 0.73, P = 0.001). In the 10 patients whose recovery was facilitated with aminophylline, MPRi-recov was 20 ± 24% lower than MPRi-rest (1.40 ± 0.35 vs. 1.73 ± 0.43, P = 0.04), indicating incomplete reversal. In 3 subjects not receiving aminophylline and 4 subjects receiving aminophylline, up-slope at recovery was greater than at stress, suggesting delayed maximal hyperemia.ConclusionsMPRi measurements from regadenoson CMR are underestimated if recovery perfusion is used as a substitute for resting perfusion, even when recovery is facilitated with aminophylline. True resting images should be used to allow accurate MPRi quantification. The delayed maximal hyperemia observed in some subjects deserves further study.Trial registrationClinicalTrials.gov NCT00871260

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