Pharmacological stress myocardial perfusion scintigraphy: use of a modified adenosine protocol in patients with asthma

Abstract

The modified adenosine infusion protocol with salbutamol premedication can be used in patients with asthma. This protocol resulted in fewer side effects and changes in BP and PR in asthmatic patients compared with nonasthmatic patients who received the standard adenosine infusion.

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

“…[29][30][31] Because of its selectivity for the A 2A receptor and not the A 2B receptor, regadenoson shows promise to avoid bronchoreactivity seen in adenosine and dipyridamole. Two small pilot studies of moderate to severe COPD and moderate asthma showed no statistically significant difference between regadenoson and placebo in bronchoconstrictive reactions as measured by spirometry.…”

Incidence of atrioventricular block with vasodilator stress SPECT: A meta-analysis

“…Similarly to what was seen for overall AVB, the incidence of high-grade AVB was significantly higher in studies using adenosine compared to regadenoson (5.21%; 95% CI 2.81%–8.30% vs 0.05%; 95% CI < 0.001%–0.19% respectively, P < .001, OR 77.2; 95% CI 20.3–293.0). No cases of SA node dysfunction were reported in any of the studies using regadenoson, as opposed to the ones using adenosine, with the majority being cases of bradycardia 3,29,38,43 and very few cases of transient sinoatrial block, 42 sinus pause 29,39 and only one case of asystole seen in the small study of nonagenarians. 31 Neither mean (or median) patient age nor prior history of diabetes, examined as covariates, exhibited significant association with rates of de novo AVB.…”

“…A total of 33 studies (19 adenosine, 14 regadenoson) reported sufficient information to calculate the incidence of high-grade AVB. 3,5,18,19,28–32,34–43,45–51,53–57 High-grade AVB was observed in 754 of 20,817 (3.62%) patients. As with the incidence of overall AVB, there was evidence of significant heterogeneity in the incidences of high-grade AVB ( Q = 1026.89, P < .001).…”

“…None of the included studies using regadenoson reported the incidence of bradycardia, sinus pause or sinus arrest. In the adenosine group, there were 28 reported cases of bradycardia, 3,29,38,43 one of which was specified as sinus bradycardia 38 and 6 reported cases of sinus pause. 29,39 Among patients receiving adenosine, there were 8 cases of transient sinoatrial block reported in the same study 42 and one case of asystole reported by Alkoutami et al which was the study assessing the incidence of AVB in nonagenarian subjects.…”

Regadenoson for myocardial perfusion scintigraphy

“…These mechanisms appear to be dependent on adenosine dose and on the severity of underlying airway disease [35]. Indeed, recent studies have consistently shown that a dose-titrated adenosine stress protocol is generally well tolerated in patients with mild or wellcontrolled asthma and chronic obstructive pulmonary disease (COPD) [35][36][37]. Symptomatic bronchospasm may occur but it reverts soon after dose reduction or discontinuation of the adenosine infusion [35].…”