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Regadenoson pharmacologic rubidium-82 PET: A comparison of quantitative perfusion and function to dipyridamole

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Journal of Nuclear Cardiology Aims and scope



Dipyridamole is used for stress 82rubidium chloride (82RbCl) PET because of its long hyperemic duration. Regadenoson has advantages of a fixed dose and favorable symptom profile, but its mean maximal hyperemia is only 2.3 minutes. To determine its suitability for 82RbCl PET, we imaged subjects using a regadenoson protocol based on its hyperemic response and compared the images in the same subjects having dipyridamole PET.


In 32 subjects (23 M), we assessed visually by blinded interpretation and quantitatively compared summed stress and difference scores, total perfusion deficit (TPD), LVEF, LV volumes, and change in stress-rest function. Linear correlation and Bland-Altman analysis of the paired measurements were applied for evaluation of differences. Paired t test and Pearson’s correlation were applied for testing of significance.


The images were interpreted the same by visual assessment. Twenty-six (26) subjects had reversible defects; by quantitation the SSS was 12.9 ± 7.0 and 14.1 ± 6.4 (P = .23) and SDS was 7.0 ± 6.8 versus 7.6 ± 6.2 (P = .40) for dipyridamole and regadenoson, respectively. Six (6) subjects had <5% likelihood of CAD and were normal by both. All paired measurements showed a high positive correlation between regadenoson and dipyridamole; stress segmental perfusion Reg = 0.93Dip + 4.4, r = 0.88; TPD Reg = 0.94Dip + 0.41, r = 0.93; LVEF Reg = 0.92Dip + 4.7, r = 0.95; stress minus rest LVEF Reg = 0.87Dip − 0.99, r = 0.82.


Regadenoson stress 82RbCl PET perfusion defect and cardiac function measurements are visually and quantitatively equivalent to dipyridamole studies and can be obtained with the clinical advantages of regadenoson.

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  1. Lieu HD, Shryock JC, von Mering GO, Gordi T, Blackburn B, Olmsted AW, et al. Regadenoson, a selective A2A adenosine receptor agonist, causes dose-dependent increases in coronary blood flow velocity in humans. J Nucl Cardiol 2007;14:514-20.

    Article  PubMed  Google Scholar 

  2. Iskandrian AE, Bateman TM, Belardinelli L, Blackburn B, Cerqueira MD, Hendel RC, et al. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol 2007;14:645-58.

    Article  PubMed  Google Scholar 

  3. Zhoghbi GJ, Iskandrian AE. Selective adenosine agonists and myocardial perfusion imaging. J Nucl Card 2012;19:126-41.

    Article  Google Scholar 

  4. Cerqueira MD, Nguyen P, Staehr P, Underwood SR, ADVANCE-MPI Trial Investigators. Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective A2A agonist regadenoson versus adenosine in myocardial perfusion imaging integrated ADVANCE-MPI trial results. JACC Cardiovasc Imaging 2008;1:307-16.

    Article  PubMed  Google Scholar 

  5. Package Insert of l.V. Persantine (dipyridamole USP), February 1991.

  6. Camp A, Chaitman BR, Goodgold H, et al. Intravenous dipyridamole and body weight considerations and dosage requirements. Am Heart J 1989;117:702-4.

    Article  PubMed  CAS  Google Scholar 

  7. Henzlova MJ, Cerqueira MD, Hansen CL, Taillefer R, Yao SS. Stress protocols and tracers, ASNC guidelines, J Nucl Cardiol 2009.

  8. Cardiogen-82 Package Insert. Bracco Diagnostics Inc., 2012.

  9. Bateman TM, Heller GV, McGhie AI, Friedman JD, Case JA, Bryngelson JR, et al. Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: Comparison with ECG-gated Tc-99m sestamibi SPECT. J Nucl Cardiol 2006;13:24-33.

    Article  PubMed  Google Scholar 

  10. Cerqueira M, Weissman N, Dilsizian V, Jacobs A, Kaul S, Laskey W, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539-42.

    Article  PubMed  Google Scholar 

  11. Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 1979;14;300:1350-8.

    Article  Google Scholar 

  12. Hsu BL, Case JA, Moser KW, Bateman TM, Cullom SJ. Reconstruction of rapidly acquired Germanium-68 transmission scans for cardiac PET attenuation correction. J Nucl Cardiol 2007;14:706-14.

    Article  PubMed  Google Scholar 

  13. Hsu BL, Moser KW, Cullom SJ, Bateman TM, Helmuth PA, Case JA. Correction of imaging artifacts from implanted leads in cardiac PET/CT: A phantom evaluation. J Nucl Med 2005;46:174P.

    Google Scholar 

  14. Hsu BL, Moser KW, Cullom JS, Bateman TM, Heller GV, Case JA. A novel Bayesian reconstruction method to correct CT image artifacts in cardiac PET/CT. J Nucl Cardiol 2005;12:S57.

    Article  Google Scholar 

  15. Slomka P, Nishina H, Berman D, Akincioglu C, Abidov A, Friedman J, et al. Automated quantification of myocardial perfusion SPECT using simplified normal limits. J Nucl Cardiol 2005;12:66-77.

    Article  PubMed  Google Scholar 

  16. Nakazato R, Berman DS, Dey D, Le Meunier L, Hayes SW, Fermin JS, et al. Automated quantitative Rb-82 3D PET/CT myocardial perfusion imaging: Normal limits and correlation with invasive coronary angiography. J Nucl Cardiol 2011;19:265-76.

    Article  PubMed  Google Scholar 

  17. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;8476:307-10.

    Article  Google Scholar 

  18. Everett B, Der G. Statistical analysis of medical data using SAS. 1st ed. London: Chapman and Hall/CRC; 2005.

    Google Scholar 

  19. Goudarzi B, Fukushima K, Bravo P, Merrill J, Bengel FM. Comparison of the myocardial blood flow response to regadenoson and dipyridamole: A quantitative analysis in patients referred for clinical Rb82 myocardial perfusion PET. Eur J Nucl Med Mol Imaging 2011;38:1908-16.

    Article  PubMed  CAS  Google Scholar 

  20. Leaker BR, O’Connor B, Hansel TT, Barnes PJ, Meng L, Mathur VS, et al. Safety of regadenoson, an adenosine A2A receptor agonist for myocardial perfusion imaging, in mild asthma and moderate asthma patients: a randomized, double-blind, placebo-controlled trial. J Nucl Cardiol 2008;15:329-36.

    Article  PubMed  Google Scholar 

  21. Prenner BM, Bukofzer S, Behm S, Feaheny K, McNutt BE. A randomized, double-blind, placebo-controlled study assessing the safety and tolerability of regadenoson in subjects with asthma or chronic obstructive pulmonary disease. J Nucl Cardiol 2012;19:681–92.

    Article  PubMed  Google Scholar 

  22. Husain Z, Palani G, Cabrera R, Karthikeyan AS, Dhanalakota S, Pathmanathan S, Jacobsen G, Ananthasubramaniam K. Hemodynamic response, arrhythmic risk, and overall safety of regadenoson as a pharmacologic stress agent for myocardial perfusion imaging in chronic obstructive pulmonary disease and bronchial asthma patients. Int J Cardiovasc Imaging 2012;28:1841–9.

    Article  PubMed  Google Scholar 

  23. Ananthasubramaniam K, Weiss R, McNutt B, Klauke B, Feaheny K, Bukofzer S. A randomized, double-blind, placebo-controlled study of the safety and tolerance of regadenoson in subjects with stage 3 or 4 chronic kidney disease. J Nucl Cardiol 2012;19:319-29.

    Article  PubMed  Google Scholar 

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The authors would like to acknowledge Bai-Ling Hsu, Ph.D. for his valuable contributions to this study.


This work was supported by an Investigator Initiated research grant from Astellas Pharma U.S.

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Correspondence to S. James Cullom PhD.

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Cullom, S.J., Case, J.A., Courter, S.A. et al. Regadenoson pharmacologic rubidium-82 PET: A comparison of quantitative perfusion and function to dipyridamole. J. Nucl. Cardiol. 20, 76–83 (2013).

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