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Feasibility, safety and accuracy of regadenoson–atropine (REGAT) stress echocardiography for the diagnosis of coronary artery disease: an angiographic correlative study

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Abstract

Regadenoson (REG), a selective A2A receptor vasodilator, has not been widely evaluated in stress echocardiography (SE). We report results of 45 patients participating in REG + atropine (REGAT) SE protocol conducted in a single-center prospective trial. The REGAT study enrolled subjects before a clinically indicated cardiac catheterization for suspected coronary artery disease (CAD). After rest imaging, a 2 mg Atropine (AT) bolus followed by 400 mcg of REG was given. Standard stress imaging views were obtained and interpreted in blinded fashion. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated using cardiac catheterization >70 % stenosis as gold standard. Additional endpoints included major adverse cardiac events (MACE) and patient questionnaire responses. The mean duration of REGAT was 18 ± 7.2 min. There were no MACE, with only transient side-effects of dry mouth, shortness of breath, and headache. The incidence of significant CAD was 51.1 %. The sensitivity and specificity for significant stenosis was 60.9 and 86.4 %, with a PPV and NPV of 82.4 and 67.9 %. By coronary territories, the sensitivity, specificity, PPV, and NPV were: left anterior descending artery 58.8, 92.9, 83.3, and 78.8 %; left circumflex artery 6.7, 93.3, 33.3, and 67.7 %; and right coronary artery 16.7, 93.9, 50, and 75.6 %. Over 90 % of subjects reported feeling comfortable, with 83 % preferring REGAT as a future stress modality. The REGAT protocol is fast, safe, and well-tolerated with good specificity for CAD detection, but its low sensitivity and NPV precludes it from being an imaging modality for routine use.

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Acknowledgments

This study was investigator initiated and funded by Astellas Pharma US, Inc. We thank Stephanie Stebens MLIS from Sladen Library Henry Ford Hospital for her expert assistance formatting the manuscript.

Conflict of interest

Dr Ananthasubramaniam receives research grants from Astellas Pharma US Inc.

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Authors and Affiliations

  1. Heart and Vascular Institute, Henry Ford Hospital, K-14, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Dee Dee Wang, Hani Saad, Mohsin Alam, Akshay Khandelwal, Kristen Brooks, Hari Iyer, Phuc Nguyen, Stephanie Boedeker & Karthik Ananthasubramaniam

  2. Seton Heart Institute, Seton Medical Center, Kyle, TX, 78640, USA

    Kamran Shaikh

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  1. Kamran Shaikh
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Correspondence to Karthik Ananthasubramaniam.

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Shaikh, K., Wang, D.D., Saad, H. et al. Feasibility, safety and accuracy of regadenoson–atropine (REGAT) stress echocardiography for the diagnosis of coronary artery disease: an angiographic correlative study. Int J Cardiovasc Imaging 30, 515–522 (2014). https://doi.org/10.1007/s10554-014-0363-6

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