Adenosine vs Regadenoson Pharmacologic Stress Differs in Women with Suspected Coronary Microvascular Dysfunction: A Report from the Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) Study
Year: 2019
Type: article
Study design: Observational Study
Abstract: Background: Stress cardiac magnetic resonance (CMR) imaging with myocardial perfusion reserve index (MPRI) measurement has emerged as a noninvasive method for assessing coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease (CAD). Pharmacologic stress with adenosine or regadenoson is typically used with comparable coronary vasodilation, but higher unadjusted MPRI has been reported with regadenoson in healthy men. This difference has not been assessed in symptomatic or healthy women. Methods: In a prospective cohort study, 139 symptomatic women with suspected CMD and no obstructive CAD underwent stress CMR and invasive coronary flow reserve (CFR) testing. Adenosine was the default vasodilator (n=99), while regadenoson was used if history of asthma or prior adenosine intolerance (n=40). Stress CMR was also performed in 40 age-matched healthy controls using adenosine (n=20) and regadenoson (n=20). Unpaired t-tests and analysis of covariance were performed to compare MPRI with adenosine and regadenoson in the symptomatic women and healthy controls. Results: Compared to regadenoson cases, adenosine cases had lower invasive CFR (2.64±0.62 vs 2.94±0.68, p=0.01) and pharmacologic heart rate change (28±16 vs 38±15 bpm, p=0.0008). Unadjusted MPRI was lower in the adenosine compared to regadenoson cases (1.73±0.38 vs 2.27±0.59, p<0.0001). When adjusted for heart rate, rate-pressure-product, and invasive CFR, MPRI remained lower in the adenosine cases (p<0.0001). Invasive CFR to adenosine correlated with adenosine MPRI (r 0.17, p=0.02) but not regadenoson MPRI (r -0.14, p=0.19). There was no significant difference in MPRI in the controls who received adenosine vs regadenoson (2.27±0.33 vs 2.38±0.44, p=0.36). Conclusion: In women undergoing stress CMR for suspected CMD, those who received adenosine had lower MPRI than those who received regadenoson. However, there were no differences in MPRI in the healthy controls. These findings suggest there may be physiologic differences in adenosine and regadenoson response in the coronary microcirculation of symptomatic women.
Authors: C. Noel Bairey Merz, Puja K. Mehta, André Rogatko, Behzad Sharif, C. Noel Bairey Merz, Carl J. Pepine, Chrisandra Shufelt, Daniel S. Berman, Eileen Handberg, Galen Cook-Wiens, George Sopko, Janet Wei, John W. Petersen, Louise E. Thomson, Manish Motwani, Sawan Jalnapurkar, Sherwin Dela Cruz, Xiao Zhang
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Awards: Women's Ischemia Syndrome Evaluation, Together: Transforming and Translating Discovery to Improve Health, G2026361351, Behavioral Medicine and Cardiovascular Research Training, EVAL OF ISCHEMIC HEART DISEASE IN WOMEN-CLINICAL CTR, EVAL OF ISCHEMIC HEART DISEASE IN WOMEN-CLINICAL CTR, ISCHEMIC HEART DISEASE IN WOMEN-CLINICAL CENTER, UCLA Clinical and Translational Science Institute, CVD protection mechanisms involving ACE2/Ang-(1-7) axis, G3751788867, ISCHEMIC HEART DISEASE IN WOMEN--CLINICAL CENTER, UF Clinical and Translational Science Award, G4144345384, G461158050, Cardiovascular Events in Women's Ischemia Syndrome Evaluation, Magnetic Resonance Imaging for Global Atherosclerosis Risk Assessment, Angiotensin and neuroimmune activation in hypertension, Women's Ischemia Syndrome Evaluation (WISE) Coronary Vascular Dysfunction, UFRCC for Cardiovascular Cell Therapy Research Network, Renin Angiotensin for Coronary Microvascular Dysfunction, General Clinical Research Center, Brain Angiotensin In Hypertensive Neurons in Culture, Cardiac Autonomic Function in Women
OpenAlex ID: W3000710395