Adenosine vs Regadenoson Pharmacologic Stress Differs in Women with Suspected Coronary Microvascular Dysfunction: A Report from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) Study.
Adenosine vs Regadenoson Pharmacologic Stress Differs in Women with Suspected Coronary Microvascular Dysfunction: A Report from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) Study.
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DOI：
10.31487/j.cdm.2019.01.01
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发表时间：
2019-01-01
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通讯作者：
Merz, C Noel Bairey
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作者：
Wei, Janet;Jalnakupur, Sawan;Merz, C Noel Bairey
背景：负荷心脏磁共振（CMR）成像结合心肌灌注储备指数（MPRI）测量已成为在没有阻塞性冠状动脉疾病（CAD）的情况下评估冠状动脉微血管功能障碍（CMD）的无创方法。腺苷或热加腺苷的药理学应激通常与可比较的冠状血管舒张作用一起使用，但据报道，在健康男性中，热加腺苷具有较高的未经调整的 MPRI。尚未在有症状或健康女性中评估这种差异。方法：在一项前瞻性队列研究中，139 名疑似 CMD 且无阻塞性 CAD 的有症状女性接受了负荷 CMR 和侵入性冠状动脉血流储备 (CFR) 测试。腺苷是默认的血管扩张剂 (n=99)，而如果有哮喘病史或既往腺苷不耐受则使用热加腺苷 (n=40)。还使用腺苷 (n=20) 和 regadenoson (n=20) 对 40 名年龄匹配的健康对照进行了压力 CMR。进行不配对 t 检验和协方差分析，以比较有症状女性和健康对照者中 MPRI 与腺苷和热加腺苷。 结果：与热加腺苷病例相比，腺苷病例具有较低的侵袭性 CFR（2.64±0.62 比 2.94±0.68，p=0.01）和药理学心率变化（28±16 比 38±15 bpm， p=0.0008）。与热加腺苷病例相比，腺苷未调整的 MPRI 较低（1.73±0.38 vs 2.27±0.59，p
Background: Stress cardiac magnetic resonance (CMR) imaging with myocardial perfusion reserve index (MPRI) measurement has emerged as a noninvasive method for assessing coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease (CAD). Pharmacologic stress with adenosine or regadenoson is typically used with comparable coronary vasodilation, but higher unadjusted MPRI has been reported with regadenoson in healthy men. This difference has not been assessed in symptomatic or healthy women.Methods: In a prospective cohort study, 139 symptomatic women with suspected CMD and no obstructive CAD underwent stress CMR and invasive coronary flow reserve (CFR) testing. Adenosine was the default vasodilator (n=99), while regadenoson was used if history of asthma or prior adenosine intolerance (n=40). Stress CMR was also performed in 40 age-matched healthy controls using adenosine (n=20) and regadenoson (n=20). Unpaired t-tests and analysis of covariance were performed to compare MPRI with adenosine and regadenoson in the symptomatic women and healthy controls.Results: Compared to regadenoson cases, adenosine cases had lower invasive CFR (2.64±0.62 vs 2.94±0.68, p=0.01) and pharmacologic heart rate change (28±16 vs 38±15 bpm, p=0.0008). Unadjusted MPRI was lower in the adenosine compared to regadenoson cases (1.73±0.38 vs 2.27±0.59, p