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Adenosine, Regadenoson Stress Echocardiography

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Stress Echocardiography

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Abstract

Vasodilator stress can be achieved with first-generation dipyridamole, second-generation adenosine, and third-generation regadenoson stress. Dipyridamole acts through the accumulation of endogenous adenosine; adenosine through the administration of exogenous adenosine; and regadenoson through selective stimulation of A2A adenosine receptors present in coronary arterioles. Stress testing with vasodilators may be performed for assessment of myocardial viability (at low dose), myocardial perfusion (intermediate dose), and myocardial ischemia (high dose). The recommended dose for adenosine is 0.14 μg/kg/min in 6′. Regadenoson is more expensive than other drugs but the fixed bolus dose simplifies the workflow and is most frequently used for perfusion imaging in the United States. Adenosine is the least well tolerated by the vasodilators with 5 to 10% limiting subjective side effects. The safety of vasodilator stress is excellent and better than dobutamine stress. Absolute contraindications are severe hypotension and severe airway obstruction. Vasodilator perfusion imaging with dipyridamole, adenosine, or regadenoson is ideally suitable for ABCDE comprehensive stress echocardiography. Adenosine is recommended for assessment of coronary perfusion or even simpler coronary flow velocity reserve in the mid-distal left anterior descending coronary artery.

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  1. Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russia

    Alla Boshchenko, Olga Zhuravleva & Alexander Vrublevsky

  2. Institute of Clinical Physiology of the National Research Council, Pisa, Italy

    Eugenio Picano

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    Eugenio Picano

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Boshchenko, A., Zhuravleva, O., Vrublevsky, A., Picano, E. (2023). Adenosine, Regadenoson Stress Echocardiography. In: Picano, E. (eds) Stress Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-031-31062-1_20

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