Regadenoson Stress Testing: A Comprehensive Review With a Focused Update

Abstract

Regadenoson is a pharmacological stress agent that has been widely used since its approval by the Food and Drug Administration (FDA) in 2008. For many years, dipyridamole and adenosine, which are non-selective adenosine receptor agonists, were more popular. However, these agents are less preferred now due to their undesirable adverse effects as compared to regadenoson. In the ADVANCE (ADenoscan Versus regAdenosoN Comparative Evaluation) phase 3 clinical trial, regadenoson demonstrated non-inferiority to adenosine for detecting reversible myocardial ischemia. This review summarizes the clinical utilities of regadenoson as the most widely used pharmacological stress agent. Moreover, the use of regadenoson has been documented in specific patient populations. Although regadenoson has established safety and efficacy in most patients with chronic diseases, there are equivocal results in the literature for other chronic diseases. It is warranted to highlight that the use of regadenoson has not been studied in patients of low socioeconomic class; it is a condition that carries a significant burden on the cardiovascular system.

Keywords: adenosine; cardiac stress test; coronary stenosis; lexiscan; myocardial perfusion imaging; non obstructive coronary artery disease; nuclear stress test; pharmacological stress agents; regadenoson; socio-economic factors.

Figure 1. The chemical structure of adenosine

National Center for Biotechnology Information (2020). PubChem Compound Summary for CID 60961, Adenosine. Retrieved October 13, 2020, from https://pubchem.ncbi.nlm.nih.gov/compound/Adenosine [10]

Figure 2. The chemical structure of regadenoson

National Center for Biotechnology Information (2020). PubChem Compound Summary for CID 219024, Regadenoson. Retrieved October 13, 2020, from https://pubchem.ncbi.nlm.nih.gov/compound/Regadenoson [10]

Figure 3. Two-dimensional reconstructive images of scintigraphy (lower images) and its correspondence to three-dimensional heart model (upper images)

Two-dimensional reconstruction of scintigraphy images representing normal perfusion patterns (lower images), in line with the minor axis (1), vertical long axis (2), and horizontal long axis (3) cross-sections and their respective corresponding anatomical cross-sections (upper images) A: anterior; AP: apical; I: inferior; L: lateral; S: septal Adapted from Mastrocola LE [24]

Figure 4. Numerical segmentation model of the left ventricular myocardium in 17 segments

Considering the tomographic slices of the minor and long vertical axes (distal or apical, middle, and basal or proximal portions), representing the myocardial regions. Furthermore, correspondence of segments may be seen as presented in the polar map, which represents radiopharmaceutical distribution throughout the left ventricular myocardium in the form of a polar map, whose center corresponds to the apex and whose peripheries correspond to the basal portions [24].