title: Regadenoson provides perfusion results comparable to adenosine in heterogeneous patient populations: a quantitative analysis from the ADVANCE MPI trials.
abstract: BACKGROUND
  Total and reversible left ventricular (LV) perfusion defect size (PDS) predict patient outcome. Limited data exist as to whether regadenoson induces similar perfusion abnormalities as observed with adenosine. We sought to determine whether regadenoson induces a similar LV PDS as seen with adenosine across varying patient populations.
  
  
  RESULTS
  ADVANCE MPI were prospective, double-blind randomized trials comparing regadenoson to standard adenosine myocardial perfusion tomography (SPECT). Following an initial adenosine SPECT, patients were randomized to either regadenoson (N = 1284) or a second adenosine study (N = 660). SPECT quantification was performed blinded to randomization and image sequence. Propensity analysis was used to define comparability of regadenoson and adenosine perfusion results. Baseline clinical and SPECT results were similar in the two randomized groups. There was a close correlation between adenosine and regadenoson-induced total (r (2) = 0.98, P < .001) and reversible (r (2) = 0.92, P < .001) PDS. Serial differences in total (0.00 ± 3.51 vs -0.11 ± 3.46, P = .51) and reversible (0.15 ± 3.79 vs 0.07 ± 3.33, P = .65) PDS were also comparable in patients randomized to regadenoson vs adenosine, respectively, and irrespective of age, gender, diabetic status, body mass index, or prior cardiovascular history. By propensity analysis, regadenoson-induced total PDS was significantly larger than observed with adenosine.
  
  
  CONCLUSIONS
  This is the first study to show that regadenoson induces similar, if not larger, perfusion defects than those observed with adenosine across different patient populations and demonstrates the value of quantitative analysis for defining serial changes in SPECT perfusion results. Regadenoson should provide comparable diagnostic and prognostic SPECT information to that obtained with adenosine.
authors.affiliation: Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist, 6550 Fannin Street, Suite 677, Houston, TX, 77030, USA, jmahmarian@houstonmethodist.org.
authors.forename: John J
authors.initials: JJ
authors.lastname: Mahmarian
authors.forename: Leif E
authors.initials: LE
authors.lastname: Peterson
authors.forename: Jiaqiong
authors.initials: J
authors.lastname: Xu
authors.forename: Manuel D
authors.initials: MD
authors.lastname: Cerqueira
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Bateman
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Thomas
authors.forename: Faisal
authors.initials: F
authors.lastname: Nabi
mesh_terms: D000241:Adenosine; D058908:Adenosine A2 Receptor Agonists; D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011687:Purines; D011720:Pyrazoles; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014665:Vasodilator Agents; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
chemical_list: D058908:Adenosine A2 Receptor Agonists; D011687:Purines; D011720:Pyrazoles; D014665:Vasodilator Agents; C430916:regadenoson; D000241:Adenosine