Selective adenosine agonists and myocardial perfusion imaging

Area of Science:

• Cardiology
• Pharmacology
• Nuclear Medicine

Background:

• Non-selective agents like adenosine and dipyridamole are used for pharmacologic stress in myocardial perfusion imaging.
• Selective adenosine receptor agonists present potential advantages for cardiac stress testing.

Purpose of the Study:

• To review pre-clinical and clinical data on selective adenosine agonist stress agents: regadenoson, binodenoson, and apadenoson.
• To focus on regadenoson due to its extensive published clinical data.
• To evaluate their utility in myocardial perfusion imaging.

Main Methods:

• Review of pre-clinical and clinical studies on selective adenosine agonists.
• Analysis of pharmacology, pharmacokinetics, pharmacodynamics, and hemodynamic effects.
• Examination of safety, side effects, drug interactions, and use in landmark trials and special populations.

Main Results:

• Selective adenosine agonists demonstrate favorable properties for cardiac stress.
• Regadenoson exhibits the most comprehensive clinical data among the agents reviewed.
• These agents are effective in inducing coronary vasodilation for myocardial perfusion imaging.

Conclusions:

• Selective adenosine receptor agonists, particularly regadenoson, represent an advancement in pharmacologic stress for myocardial perfusion imaging.
• Their distinct properties offer a favorable risk-benefit profile compared to non-selective agents.
• Further evaluation in diverse patient groups supports their clinical application.