Abstract 16817: Comparison of Diagnostic Performance of Quantitative Perfusion Stress Myocardial Perfusion Imaging With Cardiac Magnetic Resonance Between Different Vasodilators

Abstract

Introduction: Adenosine and regadenoson are commonly used vasodilators in myocardial perfusion imaging for assessment of suspected coronary artery disease. Hypothesis: The aim of this study is to determine the difference between the different vasodilators by quantifying stress and rest myocardial perfusion using cardiovascular magnetic resonance (CMR). Methods: Subjects with known or suspected CAD from 10 centers undergoing invasive coronary angiography or CT angiography were enrolled for rest and stress first-pass perfusion images using dual sequence. First-pass stress perfusion images were acquired on 1.5T or 3.0T GE scanner during adenosine or Regadenoson. Fully quantitative perfusion values were determined using Fermi deconvolution. Significant CAD was defined by: presence of≥50% stenosis in the left main coronary artery or ≥70% in the one major vessel. Diagnostic performance of stress myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) was measured using receiver operating characteristics curves. Results: A total of 89 subjects were recruited with a median age of 66 yrs, 69% men, 55% significant CAD, history of hypertension in 78%, diabetes in 48%, and hyperlipidemia in 74%. 36 subjects used adenosine, while 53 used regadenoson as the vasodilator agent. Stress MBF had a good area under the curve for adenosine vs. regadenoson [ 0.89 (0.78-1.00) vs. 0.82 (0.66-0.98), p=0.43], sensitivity (100% vs. 84%), and specificity (80% vs. 80%). MPR had a higher area under the curve for adenosine than regadenoson [0.87 (0.75-0.98) vs. 0.68 (0.52-0.84), p=0.06], sensitivity (100% vs. 61%), and specificity (68% vs. 73%). (Figure) Conclusions: Our study showed that fully quantitative perfusion using CMR, regadenoson, and adenosine have similar good diagnostic accuracy when stress MBF was used as the diagnostic parameter. However, adenosine outperformed regadenoson for the detection of significant CAD when MPR was used as the diagnostic parameter.