Abstract 10419: Safety and Accuracy of Regadenoson Bolus Real Time Perfusion Stress Echocardiography
Background: Real time perfusion myocardial contrast echocardiography (RTP-MCE) has the potential to rapidly identify myocardial blood flow abnormalities during vasodilator stress. Regadenoson (Reg) (Astellas Pharma USA) is a new selective A2a adenosine receptor agonist that can be administered as a standard dose bolus (prefilled syringe), which when combined with RTP-MCE, may rapidly identify physiologically relevant coronary artery disease (CAD) at the bedside.
Methods: To test the safety and accuracy of this technique, we analyzed both myocardial perfusion (MP) and wall motion (WM) with RTP-MCE before and after a 400 ?g bolus of Reg in 70 consecutive intermediate risk patients (31 female) undergoing coronary angiography within 30 days. Mean age was 62 years (range 30–85 years), mean BMI 30 kg/m2 (range 21–47 kg/m2). Abnormal MP was defined as a delay in myocardial contrast replenishment in any of three apical views following high mechanical index impulses at rest or following the Reg bolus. Quantitative assessments of stenosis severity (QCA) were obtained in all patients (>50% diameter considered significant), and compared to a blinded review of MP and WM.
Results: Patient demographics included hypertension in 77%, diabetes in 30%, and prior revascularization in 42%. Side effects from Reg were transient shortness of breath in 34 (49%), headache in 18 (25%), flushing in 11 (15%), and nausea in 8 patients (11%). CAD prevalence by QCA was 48% (19 patients had multi vessel CAD, 14 had one vessel CAD). MP analysis following Reg bolus had >80% sensitivity and >75%specificity for detecting significant CAD. Sensitivity was better than WM analysis (81% versus 63%) , with no difference in specificity (Figure).
Conclusions: Regadenoson stress RT-MCE is a rapid, safe, bedside method for accurately detecting physiologically relevant CAD in intermediate risk patients.
- © 2010 by American Heart Association, Inc.