Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the ADVANCE phase 3 multicenter international trial

Iskandrian, Ami E.; Bateman, Timothy M.; Belardinelli, Luiz; Blackburn, Brent; Cerqueira, Manuel D.; Hendel, Robert C.; Lieu, Hsiao; Mahmarian, John J.; Olmsted, Ann; Underwood, S. Richard

doi:10.1016/j.nuclcard.2007.06.114

Cited by 319 publications

(311 citation statements)

References 40 publications

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“…Regadenoson, approved by the United States Food and Drug Administration in April 2008, is increasingly used as a stress agent of choice because of its ease of administration as a bolus, weight-unadjusted dose, fast onset and short duration of action, sufficient hyperemic response, and comparable efficacy to adenosine but with fewer side effects. 15,16 The safety of regadenoson in patients with liver failure has been addressed in 1 study, 17 but no previous study has described the predictive value of regadenoson in patients with liver failure. Studies with adenosine SPECT imaging in patients with ESLD have also been limited, and results have been inconsistent.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Stress Myocardial Perfusion Imaging to Diagnose Coronary Artery Disease in End Stage Liver Disease Patients

Bhutani

Tobis

Gevorgyan

et al. 2013

The American Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Accuracy of Stress Myocardial Perfusion Imaging to Diagnose Coronary Artery Disease in End Stage Liver Disease Patients

Bhutani

Tobis

Gevorgyan

et al. 2013

The American Journal of Cardiology

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“…Affected coronaries fail to dilate properly resulting in a coronary steal phenomenon, manifested as a non-homogenous increase in coronary blood flow, which is reflected in the non-homogeneous distribution of the radio-isotope that can be mapped using a gamma-camera. Adenosine and ATP, and more recently a selective A2AR agonist (Lexiscan [458]), have been used as pharmacologic stressors in this setting [746][747][748][749][750][751][752][753][754]. The use of adenosine-cardiac magnetic resonance imaging for the detection of CAD has been recommended recently [755][756][757].…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Cardiac purinergic signalling in health and disease

Burnstock

Pelleg

2014

Purinergic Signalling

120

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This review is a historical account about purinergic signalling in the heart, for readers to see how ideas and understanding have changed as new experimental results were published. Initially, the focus is on the nervous control of the heart by ATP as a cotransmitter in sympathetic, parasympathetic, and sensory nerves, as well as in intracardiac neurons. Control of the heart by centers in the brain and vagal cardiovascular reflexes involving purines are also discussed. The actions of adenine nucleotides and nucleosides on cardiomyocytes, atrioventricular and sinoatrial nodes, cardiac fibroblasts, and coronary blood vessels are described. Cardiac release and degradation of ATP are also described. Finally, the involvement of purinergic signalling and its therapeutic potential in cardiac pathophysiology is reviewed, including acute and chronic heart failure, ischemia, infarction, arrhythmias, cardiomyopathy, syncope, hypertrophy, coronary artery disease, angina, diabetic cardiomyopathy, as well as heart transplantation and coronary bypass grafts.

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“…9,10 The ADVANCE MPI Trials 11,12 are randomized multicenter phase 3 trials that demonstrated the noninferiority of regadenoson to adenosine in detecting reversible defects by comparing the strength of agreement between sequential adenosine-regadenoson and adenosine-adenosine images. The HR and BP were measured at baseline and at predetermined intervals extending to 45 minutes after the administration of adenosine or regadenoson.…”

mentioning

confidence: 99%

Heart rate response during vasodilator stress myocardial perfusion imaging: Mechanisms and implications

Hage

Iskandrian

2010

Journal of Nuclear Cardiology

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See related article, pp. 617-624Myocardial perfusion imaging (MPI) using adenosine, dipyridamole, or regadenoson (a selective A 2A receptor agonist) is an established method for detecting coronary artery disease (CAD) and risk stratification. 1 In high-risk populations, as in those with diabetes mellitus (DM) or chronic kidney disease, MPI has been shown to be a powerful predictor of risk, but nevertheless, patients with normal myocardial perfusion are at higher risk than those without DM or chronic kidney disease. 2,3 Thus, there continues to be a need to extract more useful prognostic data from stress MPI especially in high-risk populations.A blunted heart rate (HR) response to exercise stress has been known to be an independent predictor of poor outcome and is used clinically in conjunction with other prognostic variables such as perfusion defects, left ventricular (LV) ejection fraction (EF) and volumes, exercise time, and symptoms during exercise to derive an overall assessment of risk in a particular patient. 4 In patients undergoing stress testing, for one reason or another, with adenosine or regadenoson (and dipyridamole, which acts indirectly by increasing interstitial levels of endogenous adenosine), there is a modest increase in HR and a modest decrease in blood pressure (BP). The increase in HR has been traditionally attributed to a reflex response to the vasodilatory effect on the systemic circulation and the resultant increase in sympathetic discharge. 5,6 The true mechanism of HR increase, however, is more complicated and involves direct stimulation of the sympathetic nervous system. 7 The administration of adenosine as a bolus, as done for the interruption of supra-ventricular tachycardias, has a negative chronotropic effect on the atrio-ventricular node via stimulation of the A1 receptor. This is in contradistinction to its effect on the A 2A receptor when given as an infusion in stress MPI studies where it induces an increase in HR. 5,8 The development of selective A 2A receptor agonists (such as regadenoson) has allowed for the dissection of the effects of adenosine on the multiple receptors. A well-done pivotal study in rats by Dhalla et al 7 that used regadenoson in combination with a selective A 2A receptor antagonist, B-blocker, a ganglionic blocker (to block the sympathetic nervous system), and a direct vasodilator (nitroprusside) demonstrated the dissociation of tachycardia and hypotension (secondary to peripheral vasodilation) responses to regadenoson. This and other data (reviewed in Ref. 9 ) confirm that A 2A receptor agonists cause a direct stimulation of the autonomic nervous system, which results in sinus tachycardia independent of the baroreflex mechanism. Thus, the change in HR in response to A 2A receptor agonists can be used to evaluate autonomic function.In order to evaluate the HR response to adenosine and regadenoson in relation to DM (since there is a high prevalence of autonomic dysfunction in patients with DM), we used data from the ADenoscan Versus RegAdenosoN Comparativ...

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Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the ADVANCE phase 3 multicenter international trial

Abstract: This phase 3 trial shows that regadenoson provides diagnostic information comparable to a standard adenosine infusion. There were no serious drug-related side effects, and regadenoson was better tolerated than adenosine.

Cited by 319 publications

References 40 publications

Accuracy of Stress Myocardial Perfusion Imaging to Diagnose Coronary Artery Disease in End Stage Liver Disease Patients

Accuracy of Stress Myocardial Perfusion Imaging to Diagnose Coronary Artery Disease in End Stage Liver Disease Patients

Cardiac purinergic signalling in health and disease

Heart rate response during vasodilator stress myocardial perfusion imaging: Mechanisms and implications

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