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Optimal timing of rest perfusion with regadenoson stress testing - normal volunteer study of quantitative MRI perfusion

Introduction

Many MRI perfusion protocols perform rest imaging a few minutes after stress imaging. Regadenoson is a new, selective Adenosine-2A receptor agonist used for myocardial perfusion imaging. The purpose of this study was to assess how well rest perfusion imaging 20 minutes after regadenoson stress reflects true baseline rest perfusion.

Hypothesis

“Rest perfusion” performed 20 minutes after regadenoson stress and reversal with aminophylline is higher than rest perfusion before administration of regadenoson.

Methods

Seventeen healthy normal volunteers with Framingham score less than 1% underwent vasodilator stress testing with regadenoson using a SSFP sequence. Rest imaging (Rest 1) was performed initially. Twenty minutes later, regadenoson 400mcg was administered as a 10 second injection with saline flush. Stress imaging was done 70 seconds after the injection. All volunteers received aminophylline 100mg. A second rest perfusion (Rest 2) imaging was done 20 minutes later. Myocardial blood flow (MBF) in ml/min/g and myocardial perfusion reserve (MPR) were quantified using a fully quantitative model constrained deconvolution (MCD).

Results

Rest 2 MBF (mean ± standard error) done 20 minutes after regadenoson stress was 1.43 ± 0.10, higher than rest perfusion done before regadenoson administration (Rest 1) is 1.18 ± 0.07, p=.009. The stress MBF is 3.72 ±0.18. Using the rest perfusion after regadenoson as true resting perfusion, leads to a 15% underestimation of MPR (2.75 ± 0.21 Stress/Rest 2 vs. 3.33 ± 0.22 Stress/ Rest1, p=0.005). Figures 1 and 2.

Figure 1
figure1

Study design

Figure 2
figure2

Rest 1, Stress and Rest 2 MBF

Conclusions

Rest perfusion done 20 minutes after regadenoson 400 mcg has not returned to baseline resting myocardial perfusion despite reversal with 100mg of aminophylline. This leads to underestimation of MPR. Regadenoson has a longer duration of effect which might be less suitable for rest perfusion done 20 minutes after stress.

Figure 3
figure3

Comparison between MPR based on Rest 1 and Rest 2 MBF.

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Correspondence to Sujethra Vasu.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Vasu, S., Bandettini, W.P., Hsu, L. et al. Optimal timing of rest perfusion with regadenoson stress testing - normal volunteer study of quantitative MRI perfusion. J Cardiovasc Magn Reson 13, P128 (2011). https://doi.org/10.1186/1532-429X-13-S1-P128

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Keywords

  • Myocardial Blood Flow
  • Aminophylline
  • Regadenoson
  • Myocardial Perfusion Reserve
  • Rest Perfusion