Hemodynamic response and diagnostic performance of regadenoson versus adenosine stress echocardiography in obstructive coronary artery disease

doi:10.3877/cma.j.issn.1672-6448.2025.12.002

Abstract

Abstract:

Objective

To compare hemodynamic responses, incidence of adverse reactions, and diagnostic performance of regadenoson (RSE) versus adenosine stress echocardiography (ASE) in patients with obstructive coronary artery disease (OCAD).

Methods

A total of 54 patients scheduled for coronary angiography (CAG) for suspected OCAD at Shaanxi Provincial People's Hospital (December 2023-April 2024) were enrolled in a two-stage randomized crossover trial (≥24 h washout). All participants underwent both RSE and ASE. Time to peak effect, heart rate (HR), systolic/diastolic blood pressure (SBP/DBP), and adverse reactions were compared. Coronary angiography (stenosis≥50% in any major epicardial vessel defined as positive) served as the gold standard. Diagnostic performance for overall OCAD was evaluated using contingency tables and area under the ROC curve (AUC), with subgroup analysis performed for patients with left anterior descending artery (LAD) lesions. AUC values were compared by the DeLong test. Other comparisons were performed using paired t-tests, Wilcoxon signed-rank tests, or chi-square tests as appropriate.

Results

Time to peak effect was shorter with RSE than with ASE [50.00 (46.47, 54.79) s vs 90.00 (88.59, 108.67) s, Z=-6.179, P＜0.001]. RSE induced a greater ΔHR increase [32.20 (25.75, 39.25) beats/min vs 23.00 (18.75, 29.25) beats/min, Z=-5.041, P＜0.001] and a more moderate ΔDBP decrease [(24.93±10.55) mmHg vs (20.63±9.61) mmHg, t=2.724, P=0.009]. The rate of adverse reactions was lower with RSE (33.33% vs 64.81%, χ²=10.71, P＜0.001). Sensitivity, accuracy, specificity, or AUC for OCAD diagnosis showed no significant differences in overall or LAD subgroup analysis (all P＞0.05).

Conclusion

Compared to ASE, RSE offers advantages including a shorter time to peak, a more pronounced heart rate response, milder blood pressure fluctuations, and a lower incidence of adverse reactions.

Key words: Coronary artery disease, Coronary arteriography, Stress echocardiography, Adenosine, Regadenoson

Xiaoli Zhu, Qianli Yang, Lu Zhang, Le Zhao, Xin Zhao, Ying Zhao, Shuixiu Dou, Xuemei Zhang. Hemodynamic response and diagnostic performance of regadenoson versus adenosine stress echocardiography in obstructive coronary artery disease[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2025, 22(12): 1106-1114.

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Figures/Tables 5

参数	ASE	RSE	统计值	P值
静息期
LVEF[%，M（Q₁，Q₃）]	60.75（56.82，66.03）	61.70（57.98，65.12）	Z=-1.089	0.276
LVEDV[ml，M（Q₁，Q₃）]	78.00（72.85，85.12）	77.50（76.36，91.92）	Z=-1.861	0.063
LVESV[ml，M（Q₁，Q₃）]	30.48（29.55，36.40）	29.00（28.37，36.11）	Z=-0.570	0.569
心率（次/min， $x ¯$ ±s）	71.31±9.79	71.69±10.42	t=-0.238	0.813
收缩压（mmHg， $x ¯$ ±s）	129.33±18.46	132.72±17.00	t=-1.576	0.121
舒张压（mmHg， $x ¯$ ±s）	73.52±11.85	76.13±10.62	t=-1.787	0.080
LAD-CFV（cm/s， $x ¯$ ±s）	22.22±5.93	21.37±4.58	t=1.009	0.318
负荷期
LVEDV[ml，M（Q₁，Q₃）]	74.00（62.50，94.05）	72.00（71.92，86.91）	Z=-0.005	0.996
LVESV[ml，M（Q₁，Q₃）]	28.00（22.00，35.00）	25.00（25.01，32.85）	Z=-1.088	0.277
心率（次/min， $x ¯$ ±s）	95.04±12.57	103.87±14.72	t=-5.820	＜0.001
收缩压（mmHg， $x ¯$ ±s）	102.20±14.59	107.93±17.76	t=-2.935	0.005
舒张压（mmHg， $x ¯$ ±s）	54.37±10.29	58.13±11.90	t=-2.574	0.013
LAD-CFV（cm/s， $x ¯$ ±s）	61.52±15.95	63.74±17.82	t=-0.905	0.370
恢复期
LVEF[%，M（Q₁，Q₃）]	67.00（63.00，69.96）	65.50（62.00，69.00）	Z=-1.198	0.231
LVEDV[ml，M（Q₁，Q₃）]	75.00（72.40，85.60）	72.00（71.92，86.91）	Z=-0.027	0.979
LVESV[ml，M（Q₁，Q₃）]	28.50（26.96，33.56）	25.00（25.01，32.85）	Z=-1.158	0.247
心率（次/min， $x ¯$ ±s）	74.7±10.97	83.96±11.35	t=-6.540	＜0.001
收缩压（mmHg， $x ¯$ ±s）	121.67±15.38	119.91±16.51	t=-0.607	0.544
舒张压（mmHg， $x ¯$ ±s）	70.20±12.72	68.87±12.83	t=-0.571	0.570
LAD-CFV（cm/s， $x ¯$ ±s）	22.72±5.77	27.89±13.61	t=-2.562	0.010
达峰时间[s，M（Q₁，Q₃）]	90.00（88.59，108.67）	50.00（46.47，54.79）	Z=-6.179	＜0.001
Δ心率[次/min，M（Q₁，Q₃）]	23.00（18.75，29.25）	32.20（25.75，39.25）	Z=-5.041	＜0.001
Δ收缩压[mmHg，M（Q₁，Q₃）]	29.50（19.75，42.00）	27.00（18.00，32.00）	Z=-1.954	0.051
Δ舒张压（mmHg， $x ¯$ ±s）	24.93±10.55	20.63±9.61	t=2.724	0.009
ΔLAD-CFV[cm/s，M（Q₁，Q₃）]	39.50（33.00，48.25）	43.00（32.00，56.50）	Z=-0.988	0.323
CFVR[M（Q₁，Q₃）]	2.83（2.61，3.09）	2.95（2.79，3.23）	Z=-1.629	0.103

参数	ASE	RSE	统计值	P值
静息期
LVEF[%，M（Q₁，Q₃）]	60.75（56.82，66.03）	61.70（57.98，65.12）	Z=-1.089	0.276
LVEDV[ml，M（Q₁，Q₃）]	78.00（72.85，85.12）	77.50（76.36，91.92）	Z=-1.861	0.063
LVESV[ml，M（Q₁，Q₃）]	30.48（29.55，36.40）	29.00（28.37，36.11）	Z=-0.570	0.569
心率（次/min， $x ¯$ ±s）	71.31±9.79	71.69±10.42	t=-0.238	0.813
收缩压（mmHg， $x ¯$ ±s）	129.33±18.46	132.72±17.00	t=-1.576	0.121
舒张压（mmHg， $x ¯$ ±s）	73.52±11.85	76.13±10.62	t=-1.787	0.080
LAD-CFV（cm/s， $x ¯$ ±s）	22.22±5.93	21.37±4.58	t=1.009	0.318
负荷期
LVEDV[ml，M（Q₁，Q₃）]	74.00（62.50，94.05）	72.00（71.92，86.91）	Z=-0.005	0.996
LVESV[ml，M（Q₁，Q₃）]	28.00（22.00，35.00）	25.00（25.01，32.85）	Z=-1.088	0.277
心率（次/min， $x ¯$ ±s）	95.04±12.57	103.87±14.72	t=-5.820	＜0.001
收缩压（mmHg， $x ¯$ ±s）	102.20±14.59	107.93±17.76	t=-2.935	0.005
舒张压（mmHg， $x ¯$ ±s）	54.37±10.29	58.13±11.90	t=-2.574	0.013
LAD-CFV（cm/s， $x ¯$ ±s）	61.52±15.95	63.74±17.82	t=-0.905	0.370
恢复期
LVEF[%，M（Q₁，Q₃）]	67.00（63.00，69.96）	65.50（62.00，69.00）	Z=-1.198	0.231
LVEDV[ml，M（Q₁，Q₃）]	75.00（72.40，85.60）	72.00（71.92，86.91）	Z=-0.027	0.979
LVESV[ml，M（Q₁，Q₃）]	28.50（26.96，33.56）	25.00（25.01，32.85）	Z=-1.158	0.247
心率（次/min， $x ¯$ ±s）	74.7±10.97	83.96±11.35	t=-6.540	＜0.001
收缩压（mmHg， $x ¯$ ±s）	121.67±15.38	119.91±16.51	t=-0.607	0.544
舒张压（mmHg， $x ¯$ ±s）	70.20±12.72	68.87±12.83	t=-0.571	0.570
LAD-CFV（cm/s， $x ¯$ ±s）	22.72±5.77	27.89±13.61	t=-2.562	0.010
达峰时间[s，M（Q₁，Q₃）]	90.00（88.59，108.67）	50.00（46.47，54.79）	Z=-6.179	＜0.001
Δ心率[次/min，M（Q₁，Q₃）]	23.00（18.75，29.25）	32.20（25.75，39.25）	Z=-5.041	＜0.001
Δ收缩压[mmHg，M（Q₁，Q₃）]	29.50（19.75，42.00）	27.00（18.00，32.00）	Z=-1.954	0.051
Δ舒张压（mmHg， $x ¯$ ±s）	24.93±10.55	20.63±9.61	t=2.724	0.009
ΔLAD-CFV[cm/s，M（Q₁，Q₃）]	39.50（33.00，48.25）	43.00（32.00，56.50）	Z=-0.988	0.323
CFVR[M（Q₁，Q₃）]	2.83（2.61，3.09）	2.95（2.79，3.23）	Z=-1.629	0.103

检查方式	敏感度（%）	特异度（%）	准确性（%）	PPV（%）	NPV（%）
RSE（CAG≥50%）	44.8	76.0	59.3	68.4	54.3
ASE（CAG≥50%）	48.3	68.0	57.4	63.6	53.1
统计值^a	0.000	0.100	0.000	0.046	0.011
P值	1.000	0.752	1.000	0.704	0.886
RSE（LAD≥50%）	46.2	75.0	61.1	63.2	60.0
ASE（LAD≥50%）	50.0	67.9	59.3	59.1	59.4
统计值^a	0.000	0.083	0.000	0.038	0.005
P值	1.000	0.773	1.000	0.755	0.955

检查方式	面部潮红	发热	头晕	胸闷胸痛	气短	心律失常	胃肠不适	合计
ASE	1（1.85）	8（14.81）	4（7.41）	1（1.85）	17（31.48）	6（11.11）	1（1.85）	35（64.81）
RSE	0（0）	5（9.26）	2（3.70）	0（0）	8（14.81）	3（5.56）	1（1.85）	18（33.33）

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