Is the dyspnea during adenosine cardiac stress test caused by bronchospasm?

Balan, K. K.; Critchley, M.

doi:10.1067/mhj.2001.116070

Cited by 33 publications

(16 citation statements)

References 6 publications

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“…After receiving regadenoson, 34% of patients experienced dyspnea 0-15 s after dosing. This dyspnea did not correlate with bronchoconstriction in this study, unlike a similar study of adenosine (51), and none of these episodes required treatment. Thomas et al (45) enrolled patients with moderate COPD (stage II) and severe COPD (stage III), according to the staging criteria of the scientific committee of the Global Initiative for Chronic Obstructive Lung Disease (52).…”

Section: Practical Aspectscontrasting

confidence: 52%

Advances in Pharmacologic Stress Agents: Focus on Regadenoson

Johnson¹,

Peters²

2010

Journal of Nuclear Medicine Technology

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Myocardial perfusion imaging using radionuclides is a wellestablished protocol for determining the diagnosis, prognosis, and management of coronary artery disease. Pharmacologic stress agents are used to induce cardiac hyperemia in patients unable to achieve the target workload by physical exercise alone. The vasodilators adenosine and dipyridamole are most commonly used, with dobutamine used only when these agents are contraindicated. However, because of frequent and intense side effects, as well as complex procedures both for patients and the nuclear medicine staff, there is room for improvement in these traditional stress agents. An ideal stress agent would be effective, safe, and well tolerated; have a simple protocol; be suitable for use in patients with reactive airway disease; and have few restrictions for the patient to adhere to before the procedure. Neither adenosine nor dipyridamole are receptorspecific, and act on A 1 , A 2A , A 2B , and A 3 adenosine receptors. As it is the A 2A receptor that mediates the desired coronary vasodilation, the A 1 , A 2B , and A 3 adenosine receptors are deemed responsible for most side effects associated with adenosine and dipyridamole. A 2A -selective pharmacologic stress agents should mediate the required hyperemic response while reducing the frequency of adverse events. The only selective A 2A adenosine receptor agonist currently approved for clinical use as a pharmacologic stress agent for myocardial perfusion imaging is regadenoson. Regadenoson has demonstrated non-inferiority to adenosine for detecting reversible myocardial perfusion defects in phase 3 trials, and patients were more comfortable during the regadenoson stress procedure than during an adenosine infusion. As regadenoson dosing is not dependent on patient weight or renal impairment and can be administered by rapid injection, it has the potential to simplify the stress procedure, reduce costs, and streamline the working day for the staff of the nuclear medicine department. In this review, the need to improve on older pharmacologic stress agents will be considered, along with an assessment of how A 2A receptor agonists fulfill that potential. Practical aspects of regadenoson are reviewed, and the impact that A 2A receptor agonist use may have on the nuclear medicine department is evaluated.

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Section: Practical Aspectscontrasting

confidence: 52%

Advances in Pharmacologic Stress Agents: Focus on Regadenoson

Johnson¹,

Peters²

2010

Journal of Nuclear Medicine Technology

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“…None of our patients had bronchospasm during adenosine infusion. This is likely to be due to our careful screening policy for asthma, although some studies have reported no major respiratory side-effects after adenosine administration even in patients with severe chronic obstructive pulmonary disease or asthma [16,17]. Adenosine has also been associated with various degrees of heart block.…”

Section: Discussionmentioning

confidence: 97%

Tolerance and safety of adenosine stress perfusion cardiovascular magnetic resonance imaging in patients with severe coronary artery disease

Karamitsos

Arnold

Pegg

et al. 2008

Int J Cardiovasc Imaging

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We sought to assess the tolerance and safety of adenosine-stress cardiovascular magnetic resonance (CMR) perfusion imaging in patients with coronary artery disease (CAD). We retrospectively examined all adenosine CMR perfusion scans performed in our centre in patients with known or suspected (CAD) and normal volunteers at either 1.5 or 3 T. All subjects were initially screened for contraindications to adenosine. The dose of adenosine infused was 140 microg/kg/min. Significant CAD was defined angiographically as the presence of at least one stenosis of >50% diameter. Data were collected from 351 consecutive subjects (mean age 62 +/- 11 years, range 25-85 years-245 men). Of the 351 subjects, 305 had a coronary angiogram, the remaining 46 subjects were normal volunteers studied for research protocols. In total, 233 subjects (76%) were found to have significant CAD of whom 128 had multi-vessel disease. There were no deaths, myocardial infarctions, or episodes of bronchospasm during the CMR study. Transient 2nd (Mobitz II) or 3rd-degree atrioventricular (AV) block occurred in 27 patients (8%). There were no sustained episodes of advanced AV block. Transient chest pain was the most common side effect (199 subjects-57%). The use of intravenous adenosine in CMR perfusion imaging is safe and well-tolerated, even in patients with severe CAD. Where a careful screening policy for contraindications to adenosine is followed, serious adverse events in the CMR scanner are relatively rare and symptoms resolve following termination of the infusion, without the need for aminophylline.

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“…13, 2009 Al Jaroudi and Iskandrian September 22, :1123 Use of Regadenoson in Stress Testing adenosine without any serious problem (39). Further, tachypnea is common after adenosine infusion and is not due to changes in airway resistance or pulmonary capillary wedge pressure but rather to stimulation of carotid body receptors (40,41). A randomized double-blind, placebo-controlled crossover trial assessed the safety of regadenoson in 48 patients with proven mild (n ϭ 24) or moderate (n ϭ 24) asthma (positive challenge test) based on the global initiative for asthma guidelines (42).…”

Section: Figure 5 Changes In Hr and Blood Pressure With Regadenoson Vmentioning

confidence: 97%

Regadenoson: A New Myocardial Stress Agent

Jaroudi

Iskandrian

2009

Journal of the American College of Cardiology

195

134

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Vasodilator stress myocardial perfusion imaging (MPI) accounts for up to 50% of all stress MPI studies performed in the U.S. In 2008, the Food and Drug Administration approved regadenoson for stress testing in conjunction with MPI. Regadenoson, unlike adenosine, is a selective A(2A) agonist that is given as an intravenous bolus at a fixed dose, with less undesirable side effects including atrioventricular block and bronchospasm. Unlike adenosine, regadenoson could be used in patients with mild-to-moderate reactive airway disease. This review will summarize the pre-clinical and clinical data on regadenoson, as they specifically relate to its use as a vasodilator stress agent, currently the only approved selective A(2A) agonist.

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Is the dyspnea during adenosine cardiac stress test caused by bronchospasm?

Cited by 33 publications

References 6 publications

Advances in Pharmacologic Stress Agents: Focus on Regadenoson

Advances in Pharmacologic Stress Agents: Focus on Regadenoson

Tolerance and safety of adenosine stress perfusion cardiovascular magnetic resonance imaging in patients with severe coronary artery disease

Regadenoson: A New Myocardial Stress Agent

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