title: Prognostic value of normal regadenoson stress perfusion cardiovascular magnetic resonance.
abstract: BACKGROUND
  Regadenoson is a vasodilator stress agent that selectively activates the A2A receptor. Compared to adenosine, regadenoson is easier to administer and results in fewer side effects. Although extensively studied in patients undergoing nuclear perfusion imaging (MPI), its use for perfusion cardiovascular magnetic resonance (CMR) is not well described. The aim of this study was to determine the prognostic value of a normal regadenoson perfusion CMR in patients with known or suspected coronary artery disease.
  
  
  METHODS
  Patients with known or suspected coronary artery disease were prospectively enrolled to receive perfusion CMR (Philips 1.5 T) with regadenoson. Three short-axis slices of the left ventricle (LV) were obtained during first pass of contrast using a hybrid GRE-EPI pulse sequence (0.075 mmol/kg Gadolinium-DTPA-BMA at 4 ml/sec). Imaging was performed 1 minute after injection of regadenoson (0.4 mg) and repeated 15 minutes after reversal of hyperemia with aminophylline (125 mg). Perfusion defects were documented if they persisted for ≥ 2 frames after peak enhancement of the LV cavity. CMR was considered abnormal if there was a resting wall motion abnormality, decreased LVEF (<40%), presence of LGE, or the presence of a perfusion defect during hyperemia. All patients were followed for a minimum of 1 year for major adverse cardiovascular event (MACE) defined as coronary revascularization, non-fatal myocardial infarction, and cardiovascular death.
  
  
  RESULTS
  149 patients were included in the final analysis. Perfusion defects were noted in 43/149 (29%) patients; 59/149 (40%) had any abnormality on CMR. During the mean follow-up period of 24 ± 9 months, 17/149 (11.4%) patients experienced MACE. The separation in the survival distributions for those with perfusion defects and those without perfusion defects was highly significant (log-rank p = 0.0001). When the absence of perfusion defects was added to the absence of other resting CMR abnormalities, the negative predictive value improved from 96% to 99%.
  
  
  CONCLUSIONS
  Regadenoson perfusion CMR provides high confidence for excellent prognosis in patients with normal perfusion.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Freed
authors.forename: Akhil
authors.initials: A
authors.lastname: Narang
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Bhave
authors.forename: Peter
authors.initials: P
authors.lastname: Czobor
authors.forename: Victor
authors.initials: V
authors.lastname: Mor-Avi
authors.forename: Emily R
authors.initials: ER
authors.lastname: Zaran
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Turner
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Cavanaugh
authors.forename: Sonal
authors.initials: S
authors.lastname: Chandra
authors.forename: Sara M
authors.initials: SM
authors.lastname: Tanaka
authors.forename: Michael H
authors.initials: MH
authors.lastname: Davidson
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL, USA. amitpatel@uchicago.edu.
authors.forename: Amit R
authors.initials: AR
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D005260:Female; D019786:Gadolinium DTPA; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009204:Myocardial Revascularization; D010477:Perfusion; D011237:Predictive Value of Tests; D011379:Prognosis; D011687:Purines / Q000008:administration & dosage / Q000009:adverse effects; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D011687:Purines; D011720:Pyrazoles; D014665:Vasodilator Agents; C430916:regadenoson; C064925:gadodiamide; D019786:Gadolinium DTPA