Pediatric Use of Regadenoson for Stress Cardiovascular Magnetic Resonance Imaging: A Systematic Literature Review

Regadenoson is a well-established selective A_2A adenosine receptor agonist able to induce coronary vasodilation, thus serving as an effective agent for stress myocardial perfusion imaging with several imaging modalities. Regadenoson is approved to be used in adults, but it is also used off-label in the pediatric setting. This paper summarizes the findings from the published literature on the use of regadenoson in pediatric populations undergoing stress CMR. Publications were identified via literature search on PubMed and Google Scholar and assessed for efficacy, adverse events, imaging-related aspects, use of stress-reversal agents, posology, and use of anesthesia. Nine publications met the criteria for this paper, reporting on a cumulative total of 276 pediatric patients, male and female, age range 2 months - 18 years, evaluated with regadenoson-based stress CMR between 2017 and 2025. Authors of all identified publications were based in the USA. In seven out of nine studies the regadenoson posology was weight-based (6-10 µg/kg). Several different contrast agents were used alongside regadenoson. No serious adverse events (AEs) were reported. All minor AEs reported in the studies were either resolved via stress-reversal agent, or self-resolved by the end of the exam. Using a random effects model that considers both within-study variance and between-study variance, the average heart rate at rest was found to be 81.9 [75.1; 88.7], and at stress 119.6 [114.9; 124.2] (delta = 37.7 bpm). In the United States, regadenoson is being used off-label for stress perfusion CMR in pediatric populations. Published reports indicate that regadenoson is efficacious and well-tolerated in this population.