Das Nikkan, Vu Eric L, Popescu Andrada, Magnetta Defne, Rigsby Cynthia K, Robinson Joshua D, Lee Simon, Husain Nazia
Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA; Nemours Children's Health, Delaware Valley, Wilmington, Delaware, USA.
Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
J Cardiovasc Magn Reson. 2025;27(1):101880. doi: 10.1016/j.jocmr.2025.101880. Epub 2025 Mar 13.
Cardiovascular magnetic resonance with myocardial stress perfusion (stress CMR) is a non-invasive technique that offers an assessment of myocardial function, perfusion, and viability. Regadenoson is a selective cardiac adenosine A2 receptor agonist with fewer side effects than adenosine and a favorable safety profile in older pediatric heart transplant recipients (PHTR). There are limited studies evaluating the hemodynamic response of regadenoson in pediatric patients under general anesthesia (GA).
We reviewed our experience with regadenoson stress CMR in PHTR under GA from 2020-2024 and compared to a non-GA group of PHTR who underwent regadenoson stress CMR from 2015-2022. Demographic and clinical data were recorded. Hemodynamic response and adverse events were reviewed. CMRs were reviewed for perfusion abnormalities and semi-quantitative analysis was performed using myocardial perfusion reserve index (MPRI).
Forty-six PHTR underwent 53 stress CMRs under GA over the study period (mean age 7.8 years; range 3-19 years). All patients received endotracheal intubation and sevoflurane and were monitored during and after regadenoson administration per institutional protocol. Heart rate (HR) prior to regadenoson administration was 84±12 beats/min with a peak of 109±14 beats/min and average mean blood pressure (BP) was 63±12 mmHg with a nadir of 45±8 mmHg. Transient hypotension was observed in 33 (77%) scans, which resolved with phenylephrine. There were no other adverse events. Phenylephrine was used in 48 CMRs (91%) for BP support at the discretion of anesthesia. Thirty-eight PHTR underwent 48 stress CMRs without sedation. CMRs were matched by time since transplant. The non-GA group was significantly older (mean age 15.8 years; p<0.001). GA patients had a larger percent decrease in mean BP compared to non-GA patients (27±17% vs 15±17%; p<0.001) with no difference in HR change. There were no significant differences in rates of qualitative perfusion defects, (11% vs 4%, p=0.18), late gadolinium enhancement or MPRI values between the two groups.
Regadenoson stress CMR is safe and feasible in PHTR under GA. While hypotension was frequently seen, it improved in all cases with phenylephrine. Semi-quantitative myocardial perfusion analysis by MPRI is feasible in these young patients, however further studies are needed to assess its clinical utility in this population.
心肌负荷灌注心血管磁共振成像（负荷CMR）是一种非侵入性技术，可用于评估心肌功能、灌注和存活情况。瑞加腺苷是一种选择性心脏腺苷A2受体激动剂，与腺苷相比副作用更少，在大龄儿童心脏移植受者（PHTR）中具有良好的安全性。评估瑞加腺苷在全身麻醉（GA）下儿科患者中的血流动力学反应的研究有限。
我们回顾了2020年至2024年期间在GA下接受瑞加腺苷负荷CMR的PHTR的经验，并与2015年至2022年期间接受瑞加腺苷负荷CMR的非GA组PHTR进行了比较。记录了人口统计学和临床数据。回顾了血流动力学反应和不良事件。对CMR进行灌注异常评估，并使用心肌灌注储备指数（MPRI）进行半定量分析。
在研究期间，46例PHTR在GA下进行了53次负荷CMR（平均年龄7.8岁；范围3至19岁）。所有患者均接受气管插管和七氟醚麻醉，并按照机构方案在瑞加腺苷给药期间和之后进行监测。瑞加腺苷给药前心率（HR）为84±12次/分钟，峰值为109±14次/分钟，平均平均血压（BP）为63±12 mmHg，最低点为45±8 mmHg。在33次（77%）扫描中观察到短暂性低血压，使用去氧肾上腺素后缓解。没有其他不良事件。根据麻醉情况，48次CMR（91%）使用了去氧肾上腺素来支持血压。38例PHTR在未使用镇静剂的情况下进行了48次负荷CMR。CMR根据移植后的时间进行匹配。非GA组年龄显著更大（平均年龄15.8岁；p<0.001）。与非GA患者相比，GA患者的平均血压下降百分比更大（27±17%对15±17%；p<0.001），HR变化无差异。两组之间在定性灌注缺陷率（11%对4%，p=0.18）、钆剂延迟强化或MPRI值方面没有显著差异。
瑞加腺苷负荷CMR在GA下的PHTR中是安全可行的。虽然低血压很常见，但在所有病例中使用去氧肾上腺素后均得到改善。通过MPRI进行半定量心肌灌注分析在这些年轻患者中是可行的，然而需要进一步研究来评估其在该人群中的临床效用。
