Impact of a regimented aminophylline administration protocol on the burden of regadenoson-induced ischemia detected by SPECT myocardial perfusion imaging

Abstract

In patients undergoing regadenoson-stress SPECT-MPI, the intravenous administration of 75 mg of aminophylline as early as 90 seconds after radioisotope injection does not seem to attenuate the burden of myocardial ischemia.

Stress SPECT Myocardial Perfusion Imaging in End-Stage Renal Disease

“…(24–26) Administering aminophylline to prevent or treat regadenoson-related adverse effects has been shown to have no demonstrable effect on the burden of regadenoson-induced myocardial ischemia detected by SPECT-MPI. (27) Therefore, regadenoson is safe and generally well-tolerated in ESRD patients, and in January 2017, was approved by the Food and Drug Administration (FDA) for use in patients with ESRD. (28)…”

Effect of aminophylline administration on the diagnostic yield of vasodilator myocardial perfusion imaging

“…3,7 Aminophylline, a nonselective adenosine receptor antagonist, has been available on the market for decades and used to reverse the adverse effects of dipyridamole and adenosine and more recently been shown to be safe and effective for use with regadenoson. 8,9 In this issue of the Journal, Fughhi et al 10 address the concern that use of aminophylline to ameliorate the adverse effects of regadenoson may reverse its effects on coronary vasodilation and subsequent myocardial hyperemia reducing the sensitivity of MPI for detecting perfusion abnormalities. The data for the current study were pooled from two double-blinded, placebo-controlled randomized clinical trials, the ASSUAGE and ASSUAGE-CKD trials, 9,11 which demonstrated the effectiveness of aminophylline in attenuating the adverse effects associated with regadenoson in patients undergoing MPI.…”

“…14 Thus, at least theoretically, antagonism of adenosine receptors at least 100 seconds after regadenoson administration should not interfere with myocardial uptake of the tracer. Based on these data, and allowing 10 seconds for the drug to reach the coronary capillary bed, The ASSUAGE trials, on which the study by Fughhi et al 10 is based, administered aminophylline at 90 seconds after tracer administration.…”

“…It is important to interpret the results of the study by Fughhi et al 10 with caution since the findings are based on post hoc analysis of studies that were not designed or powered to address this issue. As pointed out earlier, the higher prevalence of abnormal myocardial perfusion in the placebo group is another reason to pause when interpreting the findings although the authors have attributed this to the imbalance in the distribution of patients with prior MI between the 2 randomized groups.…”

“…In line with this view, the recently released American Society of Nuclear Cardiology imaging guidelines for SPECT nuclear cardiology procedures: Stress protocols and tracers states that ingestion of caffeinated foods or beverages within the last 12 hours prior to regadenoson MPI (or other vasodilator stress agents) should be avoided but downgraded this from an absolute to a relative contraindication. 23 The study by Fughhi et al 10 provides some reassurance that administration of aminophylline, when delayed by at least 2 minutes, does not substantially interfere with the effects of regadenoson on myocardial perfusion by MPI. Therefore, when significant complications are encountered as summarized in the recent guidelines, 23 reversal of regadenoson should be considered without concern for altering findings on imaging.…”