Background
The diagnostic performance of cardiovascular magnetic resonance (CMR) utilizing adenosine
for detection of myocardial ischemia is well established. However, adenosine requires
continuous infusion, which is challenging in the CMR environment, and has frequent
side effects. The diagnostic accuracy of stress CMR using regadenoson, a newer vasodilator
agent that is administered as a single bolus injection and has fewer side effects,
has not been well studied. The aims of this study were: (1) to determine the diagnostic
accuracy of regadenoson stress CMR when compared to coronary angiography in patients
with suspected coronary artery disease (CAD), and (2) to study outcomes in patients
with negative stress CMR perfusion studies to confirm that there are not a significant
number of "abnormal studies" that are undetected.
Methods
We studied 126 patients with suspected CAD referred for regadenoson stress CMR (1.5
T scanner, Philips). Stress perfusion images were obtained during the first pass of
Gadolinium contrast agent one minute after regadenoson (0.4mg IV bolus) injection,
and followed by reversal with aminophylline (75-125 mg). Cine imaging was followed
by rest perfusion and late gadolinium enhancement imaging 10-15 minutes later. Patients
were divided into 2 groups according to probability of CAD. Group 1 included 38 patients,
who underwent coronary angiography within 6 months of CMR (Table), and was used to
achieve goal 1. Significant CAD was defined by >70% coronary stenosis. Group 2 included
88 patients with normal regadenoson CMR (defined by normal right and left ventricular
systolic volumes and function, absence of both visible perfusion abnormalities and
LGE) who were followed-up for 12 months for cardiac death, myocardial infarction (MI),
and revascularization. This group was used to achieve goal 2.
Results
In group 1, 29/38 (76%) patients had significant CAD, and 35/38 (92%) had visible
stress-induced perfusion abnormalities on CMR. The diagnostic accuracy of regadenoson
CMR was 89%, sensitivity 93%, specificity 89%, positive predictive value (PPV) 96%,
and negative predictive value (NPV) 72%. In group 2, none of the 88 patients had events
within the follow-up period.
Conclusions
This study provides one of the first assessments of diagnostic performance of regadenoson
stress CMR in clinical practice, which was similar to published data for adenosine
stress CMR. Importantly, the one-year event rate in patients with normal stress exams
was <1/88, i.e. <1.14%. With its known advantages over adenosine, regadenoson is an
effective alternative for cardiac MRI vasodilator stress testing in both patients
with high and low probability of CAD.
Funding
N/A.
Table 1
Patient Characteristics
Men, n
15
Women, n
23
No Prior Coronary Disease, n
18
Prior PCI and/or CABG, n
20
Hypertension, n
34
Hyperlipidemia, n
35
Diabetes, n
12
Tobacco Use, n
13
Family History, n
7