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Journal of Cardiovascular Magnetic Resonance

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Open Access 01-12-2012 | Research

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

Authors: Nicole M Bhave, Benjamin H Freed, Chattanong Yodwut, Denise Kolanczyk, Karin Dill, Roberto M Lang, Victor Mor-Avi, Amit R Patel

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2012

Abstract

Background

Adenosine 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.

Methods

Twenty 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).

Results

In 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.

Conclusions

MPRi 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 registration

ClinicalTrials.gov NCT00871260

Available only for authorised users

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Title: Considerations when measuring myocardial perfusion reserve by cardiovascular magnetic resonance using regadenoson
Authors: Nicole M Bhave
Benjamin H Freed
Chattanong Yodwut
Denise Kolanczyk
Karin Dill
Roberto M Lang
Victor Mor-Avi
Amit R Patel
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2012
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/1532-429X-14-89

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

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