Rapid Fire Abstracts
Shuo Wang, MD, PhD
Research Associate
University of Virginia Health System
.jpg "Patricia Rodriguez-Lozano, MD,MS photo")
Patricia Rodriguez-Lozano, MD,MS
Director Women's Heart Program
University of Virginia
Shuo Wang, MD, PhD
Research Associate
University of Virginia Health System
Ming-Yen Ng, BMBS FRCR FSCMR
Clinical Associate Professor
The University of Hong Kong, Hong Kong
Haonan Wang, PhD
Lead Scientist, Cardiac MR
GE Healthcare
Hena Patel, MD
Assistant Professor
University of Chicago Medicine
Saima Mushtaq, MD
Cardiologist
Centro Cardiologico Monzino IRCCS, Italy
Andrew Arai, MD
Professor
Division of Cardiovascular Medicine, Department of Medicine, Department of Radiology, University of Utah School of Medicine
Ibrahim M. Saeed, MD
Cardiologist
Virginia Heart / Inova Schar Heart and Vascular
Amita Singh, MD
Cardiologist
Central Dupage hospital
Paul J. Kim, MD
Asst Professor
University of California, San Diego
Michael Salerno, MD, PhD
Cardiology Professor
Stanford University
Jason Sin
Research
The University of Hong Kong, Hong Kong
Elizabeth Hillier, MD, PhD
Resident Physician
McGill University Health Centre, Canada
Christian Østergaard Mariager, PhD
MR Physicist
Aarhus University Hospital, Denmark
Gianluca Pontone, MD, PhD
Cardiologist
Centro Cardiologico Monzino IRCCS, University of Milan, Italy
Simon Madsen, MD
Cardiologist
Aarhus University Hospital, Aarhus, Denmark
José Vicente Monmeneu Menadas, MD, PhD
Physician
Ascires Biomedical Group, Spain
Alicia M. Maceira, MD, PhD, FSCMR
Cardiologist
Cardiovascular Unit. Cardiology Department. Ascires Biomedical Group, Spain
Yuko Tada, MD, PhD
Research
University of California, San Diego
Aju Paul Pazhenkottil, MD
Senior Consultant Cardiac Imaging
University Hospital Zurich, Switzerland
Javier Urmeneta, MD
Cardiologist
IDCQ Hospitals and Health SL, Spain
Alborz Amir-Khalili, PhD
Director AI Development
Circle Cardiovascular Imaging, Canada
Mitchel Benovoy, PhD
PhD
Area 19 Medical Inc., Canada
Silke Friedrich, MD
VP Clinical Affairs
Area 19 Medical Inc., Canada
Martin A. Janich, PhD
Director, Cardiac MRI
GE HealthCare, Germany
Matthias G. Friedrich, MD
Full Professor
McGill University Health Centre
Mc Gill University, Canada
Amit R. Patel, MD
Professor of Medicine
Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA.
Previous studies have shown that visual assessment of stress CMR images provides similar diagnostic accuracy between different vasodilators. However, the diagnostic performance of quantitative perfusion using different vasodilator agents has not been established. This study aims to compare the diagnostic accuracy of myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) measurements made using adenosine versus regadenoson stress CMR for the detection of obstructive CAD.
Methods:
Subjects with known or suspected CAD from 10 centers undergoing invasive coronary angiography or CT angiography were enrolled. Adenosine or regadenoson stress followed by rest first-pass perfusion images were acquired using a dual-sequence CMR protocol on 1.5T or 3.0T GE HealthCare scanners. Rest perfusion images were acquired 5-15 minutes following either cessation of adenosine or reversal with aminophylline in cases of regadenoson use. Fully quantitative perfusion values were determined using Fermi deconvolution implemented on CircleCVI QP software. Significant CAD was defined as the presence of ≥50% stenosis in the left main coronary artery or ≥70% in one major vessel. The diagnostic accuracy of stress MBF and MPR for detecting obstructive CAD was assessed using receiver operating characteristic (ROC) curves.
Results:
A total of 122 subjects were recruited (median age 66 years; 28% women, and 63% with significant CAD). Demographic data are shown on Table 1. Stress MBF demonstrated similar diagnostic accuracy between adenosine and regadenoson, with comparable areas under the curve (AUC) [0.88 (0.78-0.97) vs. 0.86 (0.71-0.99), sensitivity (89% vs. 86%), and specificity (85% vs. 82%). However, MPR calculated in the adenosine group had a higher diagnostic accuracy than in the regadenoson group [AUC: 0.87 (0.78-0.96) vs. 0.78 (0.63-0.92), sensitivity (82% vs. 73%), and specificity (84% vs. 69%) (Figure)]. Compared to adenosine, MPR values were lower in the regadenoson group, likely due to higher rest MBF values (1.03 ± 0.22ml/kg/min vs 1.08 ± 0.17ml/kg/min).
Conclusion: This multicenter pragmatic study demonstrates that adenosine and regadenoson have a similar diagnostic accuracy for detecting obstructive CAD when using stress MBF values measured by CMR. However, because of variable residual vasodilatory effects on resting MBF values, MPR may have a lower diagnostic accuracy during regadenoson stress CMR compared to adenosine. These findings highlight the importance of standardized imaging protocols and suggest that further investigation is needed determine whether a stress-first or a rest-first imaging protocol is preferred when quantifying MPR during a regadenoson stress CMR exam.
