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

Abstract

Regadenoson (REG) is a A2a receptor selective pharmacologic SPECT imaging agent. Its safety in unselected chronic obstructive pulmonary disease (COPD) or asthma (AM) undergoing SPECT imaging has not been well evaluated. We retrospectively identified 228 patients (COPD n = 126 and AM n = 102, Grp 1) undergoing REG SPECT from Jan to Nov 2009 and compared to 1,142 patients without COPD and AM (control, Grp 2). A standard 400 μg REG bolus was used and gated Tc-99 m tetrofosmin SPECT done. Patient demographics, REG SPECT data, side effects, arrhythmia occurrences, and any exacerbation of COPD or AM leading to treatment, hospitalization or death were evaluated. The side effect profile of Grp 1 was also compared to a historical cohort who underwent intravenous dipyridamole thallium-201 imaging and adenosine SPECT. Both groups were comparable with regards to baseline characteristics. There was 0% incidence of clinical exacerbation of COPD or AM after REG. COPD patients had more non-significant arrhythmias (58.3% vs. Grp 2, 43%, P = 0.004). There was 0% incidence of any atrio-ventricular block and only 2 instances of brief supraventricular tachycardia. When compared to the historical cohort of COPD who underwent IV dipyridamole thallium imaging, COPD in Grp 1, had more dyspnea and flushing and when compared to COPD/AM patients who underwent adenosine SPECT, Grp 1 pts had more of flushing and headache (24.9% vs. 2.8%, P = <0.001) but less of bronchospasm (1.3% vs. 6.9%, P = 0.022) and AV block (0% vs. 4.2%, P = 0.014). REG SPECT can be safely performed in COPD and AM population.

Safety and tolerability of regadenoson CMR

“…However, multiple studies evaluated the specific safety of regadenoson in patients with COPD and asthma and found no increase in acute COPD or asthma exacerbation. 9,10,24 …”

“…2–4 Regadenoson is also safe in patients with stage 3–4 renal failure, 5,6 end-stage liver disease, 7 post-cardiac transplant, 8 chronic obstructive pulmonary disease (COPD) and mild-to-moderate asthma. 9,10 However, there is a paucity of data to address the safety and tolerability of regadenoson in perfusion CMR, 11,12 where ECG monitoring is less reliable due to magnetohydrodynamic effects 13 and resuscitation necessitates prompt removal of the patient from the scanner. Knowledge of the adverse events associated with regadenoson perfusion CMR has implications for patient safety and staff training.…”

Adverse effects associated with regadenoson myocardial perfusion imaging

“…41,42 The above findings have been confirmed by larger studies showing a safe and favorable pulmonary profile of regadenoson. 43 Adding low level exercise to regadenoson has been proposed as one way to attempt to decrease the development of pulmonary side effects and improve tolerability in patients with COPD and/or asthma. 35,44 Data are still limited and definitive conclusions cannot be drawn.…”

Nuclear Cardiology: 2014 Innovations and Developments

“…[12][13][14][15] In two early, small, double-blind, placebo-controlled, crossover studies, regadenoson did not reduce forced expiratory volume in 1 second (FEV1) on serial pulmonary function testing or oxygen saturation as compared to placebo saline infusion. A more recent double-blind, randomized, placebo-controlled trial of 999 subjects (532 with asthma and 467 with COPD) evaluated the effects of regadenoson vs saline infusion using serial pulmonary function tests over a several-hour period postinjection.…”