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Updated: Oct 24, 2025
Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders
Published on: February 3, 2021
Quantitative myocardial perfusion response to adenosine and regadenoson in patients with suspected coronary artery
Tanja Kero1,2, Antti Saraste3,4, Bo Lagerqvist5,6
1Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden. tanja.kero@radiol.uu.se.
Insights
Regadenoson and adenosine show strong correlation for myocardial blood flow (MBF) in coronary artery disease (CAD) patients. However, moderate agreement suggests caution when using regadenoson with established 15O-water PET imaging cut-offs.
Area of Science:
- Cardiovascular Imaging
- Nuclear Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) diagnosis often relies on assessing myocardial blood flow (MBF).
- Pharmacological stressors like adenosine and regadenoson are used to induce hyperemia for MBF assessment.
- 15O-water PET imaging provides quantitative MBF measurements.
Purpose of the Study:
- To compare the quantitative flow responses of regadenoson versus adenosine.
- To evaluate regadenoson as a vasodilator in patients with suspected or known CAD.
- To assess the utility of regadenoson in conjunction with 15O-water PET imaging.
Main Methods:
- A comparative study involving 21 patients with suspected or known CAD.
- 15O-water PET imaging was performed at rest and during hyperemia induced by both adenosine and regadenoson.
- Quantitative myocardial blood flow (MBF) was measured and analyzed using correlation and Bland-Altman methods.
Main Results:
- Rest and stress MBF values were similar between adenosine and regadenoson (P = 0.55 and P = 0.49, respectively).
- Strong correlations were observed between global and regional stress MBF calculated using adenosine and regadenoson (r = 0.80 and r = 0.77).
- While biases were small, the limits of agreement for stress MBF were wide, indicating moderate agreement.
Conclusions:
- Regadenoson demonstrates a strong correlation with adenosine for inducing hyperemic MBF.
- The moderate agreement between the two vasodilators suggests caution when applying established 15O-water PET cut-off values with regadenoson.
- Further validation is needed for regadenoson's use with existing quantitative MBF criteria in 15O-water PET.
Background:
The aim of the present study was to compare the quantitative flow responses of regadenoson against adenosine using cardiac 15O-water PET imaging in patients with suspected or known coronary artery disease (CAD).
Methods:
Hyperemic myocardial blood flow (MBF) after adenosine and regadenoson was compared using correlation and Bland-Altman analysis in 21 patients who underwent rest and adenosine 15O-water PET scans followed by rest and regadenoson 15O-water PET scans.
Results:
Global mean (± SD) MBF values at rest and stress were 0.92 ± 0.27 and 2.68 ± 0.80 mL·g·min for the adenosine study and 0.95 ± 0.29 and 2.76 ± 0.79 mL·g·min for the regadenoson study (P = 0.55 and P = 0.49). The correlations between global and regional adenosine- and regadenoson-based stress MBF were strong (r = 0.80 and r = 0.77). The biases were small for both global and regional MBF comparisons (0.08 and 0.09 mL·min·g), but the limits of agreement were wide for stress MBF.
Conclusion:
The correlation between regadenoson- and adenosine-induced hyperemic MBF was strong but the agreement was only moderate indicating that established cut-off values for 150-water PET should be used cautiously if using regadenoson as vasodilator.
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