Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2024 Oct 1.
Published in final edited form as: J Nucl Cardiol. 2023 Jul 19;30(5):2187–2190. doi: 10.1007/s12350-023-03337-w

PET myocardial perfusion imaging of regadenoson-induced coronary vasospasm

Iqra Qamar a,b, Simran Grewal a,b, Akl C Fahed a,c, Rory Weiner a, Ahmed Tawakol a,b, Michael T Osborne a,b
PMCID: PMC10591791  NIHMSID: NIHMS1932378  PMID: 37468744

INTRODUCTION

Coronary vasospasm involves transient vasoconstriction of an epicardial coronary artery or the coronary microvasculature that may result in partial or complete coronary occlusion and compromised myocardial perfusion.1 Positron emission tomography (PET) myocardial perfusion imaging (MPI) allows assessment of myocardial ischemia and myocardial blood flow (MBF). Coronary vasospasm with regadenoson administration has been described, but there is no report of regadenoson-induced coronary vasospasm during PET MPI.2,3

CASE SUMMARY

A 67-year-old female with hypercholesterolemia, anxiety, and prior left-sided breast cancer treated with chemotherapy, radiation, and mastectomy presented with one month of Canadian Cardiovascular Society Class IV angina for regadenoson 82Rubidium PET MPI. Following regadenoson infusion, she developed chest pain, and her electrocardiogram (ECG) showed anterolateral ST elevations that resolved with nitroglycerin and aminophylline (Fig. 1). MPI showed severe anteroseptal, anterior, inferior, lateral, and apical ischemia with transient ischemic dilation (Fig. 2A and B). Peak MBF and myocardial flow reserve were diffusely reduced with the greatest reductions in the left anterior descending territory (Fig. 2C). Stress left ventricular ejection fraction decreased to 45% from 68% at rest. She was scheduled for a functional coronary angiogram to assess for obstructive disease, microvascular disease, and coronary reactivity. Coronary angiogram showed mild plaque without obstructive disease and ostial left main coronary spasm (Fig. 3). Even after intra-coronary nitroglycerin and nicardipine and catheter disengagement, cyclical episodes of chest pain, ST elevations, and hypotension continued every few minutes over approximately forty minutes that were similar to her presenting symptoms. The functional coronary angiogram was aborted for safety. She was discharged on medical therapy to prevent vasospasm.

Fig. 1.

Fig. 1.

Open in a new tab

A Baseline resting electrocardiogram (ECG) shows normal sinus rhythm with minor ST T-wave abnormalities. B ECG during regadenoson infusion shows ST elevations in leads I, aVL, and V2 with corresponding ST depressions in leads II, III, and aVF that resolved with nitroglycerin and aminophylline administration.

Fig. 2.

Fig. 2.

Open in a new tab

82Rubidium positron emission tomography myocardial perfusion imaging. A Qualitative images showed transient ischemic dilation (TID) with severe ischemia of the anteroseptum, anterior wall, inferior wall, lateral wall, and apex (TID ratio was 1.45). B Polar maps demonstrated the extent and severity of the reversible perfusion defect. C Quantitative analysis showed reduced stress myocardial blood flow (MBF) and myocardial flow reserve in all coronary territories with the greatest reductions in the territory of the left anterior descending artery. HLA horizontal long axis, LAD left anterior descending, LCx left circumflex, RCA right coronary artery, SA short axis, SDS Summed Difference Score, SRS Summed Rest Score, SSS Summed Stress Score, VLA vertical long axis.

Fig. 3.

Fig. 3.

Open in a new tab

Coronary angiography showing the A left coronary system without obstructive disease, B right coronary artery without obstructive disease, and C left coronary system with vasospasm of the ostial left main coronary artery (red arrow) during the procedure in the context of severe pain, electrocardiographic changes, and hypotension.

CONCLUSION

Coronary vasospasm has been described with regadenoson infusion. In this case, PET MPI illustrated the profound extent and severity of myocardial ischemia consequent to coronary vasospasm.

Funding

Dr. Osborne is partially supported by United States National Institutes of Health (NIH) #K23HL151909. Dr. Fahed is partially supported by NIH # K08HL161448.

Footnotes

Disclosures

AF is co-founder of Goodpath and has received grant funding from Abbott Vascular. MO receives consulting fees from WCG Imaging, LLC for unrelated work. AT’s institution receives grant support from Lung Biotechnology for unrelated work.

References

  • 1.Picard F et al. (2019) Vasospastic angina: a literature review of current evidence. Arch Cardiovasc Dis 112(1):44–55. 10.1016/j.acvd.2018.08.002 [DOI] [PubMed] [Google Scholar]
  • 2.Platsman Z, Auerbach A, Lee A et al. (2016) Regadenoson-induced coronary vasospasm resulting in severe reversible perfusion defects and transient ischemic dilation on SPECT stress myocardial perfusion imaging. J Nucl Cardiol 23:843–845. 10.1007/s12350-015-0275-4 [DOI] [PubMed] [Google Scholar]
  • 3.Fogelson B et al. (2022) Inferior myocardial infarction secondary to coronary artery vasospasm following regadenoson stress imaging. J Med Cases 13(1):11–14. 10.14740/jmc3850 [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES