Abstract 19899: Cardiac MR Stress Perfusion With Regadenoson or Dobutamine in Children Single Center Experience in Repaired & Unrepaired Congenital & Acquired Heart Disease
Introduction: Myocardial perfusion assessment in children is a growing need given improved survival of congenital heart disease and increasing acquired coronary disease. Pharmacologic stress cardiac MRI (CMR) is routinely utilized in adults, but rarely in children. Regadenoson has a favorable side effect profile, but has not been reported in pediatrics. We aimed to observe the safety and feasibility of regadenoson and dobutamine as pharmacologic stressors (PS) for CMR in a cohort of pediatric patients with increased risk of myocardial ischemia, compared to nuclear stress perfusion (NSP) or cardiac catheterization (CC), when available.
Methods: We reviewed our experience with regadenoson and dobutamine CMR. All CMR exams due to clinical concern for ischemia. PS achieved by either 400 mcg of regadenoson prior to perfusion assessment or dobutamine escalation to 40 mcg/kg/min. Rest/stress myocardial perfusion and viability assessed. Ventricular wall motion assessed with cine SSFP imaging. CMR perfusion and viability images jointly assessed by a pediatric cardiologist and radiologist. NSP images assessed by a radiologist blinded to CMR results.
Results: Total of 73 subjects (age 15.4 +/- 4.7 yrs, range of 10-22 yrs) included with most common diagnoses being anomalous origin of coronary (27), D-transposition of the great arteries (14), Kawasaki disease (12), Ross procedure (7) and myocardial bridge (4). All exams completed without serious adverse events, 36 by regadenoson. NSP also performed in 32 and 20 had CC with angiography and/or fractional flow reserve with PS. Discrepancy of identification or reversibility of perfusion defect between CMR and NSP tests seen in 14, 10 of whom had CC following CMR. CC confirmed CMR findings in all 10 cases, 5 demonstrated reversibility on CMR and CC, while NSP demonstrated fixed defect. Three patients with normal CMR and abnormal NSP had normal CC. Two patients had reversibility by NSP, but CMR and CC revealed scar with no reversibility.
Conclusion: Regadenoson and dobutamine CMR appears to be a safe and feasible method of PS testing in the pediatric population with an increased risk of coronary ischemia and may be a more accurate measure of provocative testing than NSP.
Author Disclosures: C.V. Noel: None. R. Krishnamurthy: None. S. Molossi: None. B. Moffett: None. R. Krishnamurthy: None.
- © 2016 by American Heart Association, Inc.