Rapid Detection of Coronary Artery Stenoses with Real Time Perfusion Echocardiography During Regadenoson Stress.
Circ Cardiovasc Imaging. 2011 Sep 23;
Authors: Porter TR, Adolphson M, High RR, Smith LM, Olson J, Erdkamp M, Xie F, O'Leary E, Wong BF, Eifert-Rain S, Hagen ME, Abdelmoneim SS, Mulvagh SL
BACKGROUND: -Real time myocardial contrast echocardiography (RTMCE) permits the detection of myocardial perfusion abnormalities during stress echocardiography that may improve the accuracy of the test in detecting coronary artery stenoses (CAD). We hypothesized that this technique could be utilized following a bolus injection of the selective A2A receptor agonist regadenoson (Astellas Pharma) to rapidly and safely detect CAD. METHODS AND RESULTS: -In 100 patients referred for quantitative coronary angiography (QCA), RTMCE was performed during a continuous intravenous infusion of 3% Definity (Lantheus Medical Imaging) at baseline and at two minute intervals for up to six minutes following a regadenoson bolus injection (400 ug). Myocardial perfusion was assessed by examining myocardial contrast replenishment (MCR) following brief high mechanical index impulses. A perfusion defect was defined as a delay (>2 seconds) in MCR in two contiguous segments. Wall motion (WM) was also analyzed. The overall sensitivity/specificity/accuracy for myocardial perfusion analysis in detecting a >50% diameter stenosis was 80%/74%/78%, while for WM analysis it was 60%/72%/66% (p<0.001 for differences in sensitivity). Sensitivity for myocardial perfusion analysis was highest on images obtained during the first two minutes following regadenoson bolus (p<0.001 compared to wall motion), while wall motion sensitivity was highest at the 4-6 minute period following the bolus.No significant side effects occurred following regadenoson bolus injection. CONCLUSIONS: -Regadenoson RTMCE appears to be a feasible, safe, and rapid non-invasive method for the detection of significant coronary artery stenoses. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT0087369.
PMID: 21946702 [PubMed - as supplied by publisher]