Using regadenoson for stress first-pass perfusion cardiac MR imaging: How, when, and why?

Cardiac magnetic resonance imaging (MRI) is a valuable tool for ruling out coronary artery disease, assessing cardiac viability, diagnosing myocardial ischemia, and providing prognostic information. Cardiac MRI, including vasodilator-induced first-pass perfusion imaging, is recommended for patients with a high probability of coronary disease, prior to revascularization, and when a viability assessment is necessary. Adenosine is the most commonly used vasodilating agent for stress cardiac MRI worldwide. However, regadenoson, which is an adenosine A2A receptor agonist, is a highly suitable alternative for stress cardiac MRI due to its kinetic properties, ease of use, single-dose administration, limited contraindications, and prognostic value. This technical note describes the characteristics and safety profile of regadenoson and discusses its application to cardiac MRI and reimbursement issues.