Regadenoson in Europe: first-year experience of regadenoson stress combined with submaximal exercise in patients undergoing myocardial perfusion scintigraphy

Abstract

PurposeRegadenoson was approved for clinical use in Europe in 2011. Since then, it has become the default form of stress at our institution. We have assessed the side-effect profile and tolerability of regadenoson in patients undergoing clinically indicated myocardial perfusion scintigraphy between July 2011 and July 2012.MethodsClinical, stress and imaging data were recorded prospectively. Symptoms during stress were recorded and defined as mild, moderate or severe. An adverse event was defined as any symptom that persisted for more than 30 min or that required investigation or treatment.ResultsOf 1,764 consecutive patients, 1,581 (90 %) received regadenoson combined with submaximal exercise unless contraindicated. Symptoms were common (63 %) but transient and well-tolerated. The severity of symptoms was recorded in most patients as mild (84 %). Dyspnoea (36 %) and chest discomfort (12 %) were the commonest side effects. Adverse events were reported in eight patients (0.5 %), thought to be vasovagal in seven of these. All patients recovered fully without sequelae. There were no deaths, myocardial infarction or hospital admissions. Regadenoson stress was performed in 206 patients (12 %) with asthma or chronic obstructive pulmonary disease (COPD) without bronchospasm or any other major side effect.ConclusionWe studied the symptom profile of regadenoson in the largest European cohort to date. Regadenoson combined with submaximal exercise was well tolerated, notably also in patients with asthma or COPD. The majority of regadenoson-related adverse events were vasovagal episodes without sequelae.

Regadenoson for myocardial perfusion imaging: Is it safe?

“…In this study, there were 8 adverse events (0.5%) but no deaths, MIs, or hospital admission following stress MPI. 17 The mechanism for the possible association between regadenoson administration and acute MI is not clear. Similar associations have been reported with adenosine and dipyridamole.…”

Adverse effects associated with regadenoson myocardial perfusion imaging

“…4 Despite this initial observation, there have since been isolated case reports and small case series describing the occurrence of de novo advanced heart block and asystole following regadenoson and requiring immediate management and stabilization. [29][30][31][32][33][34][35] As of June 2017, a total of 56 cases of third-degree heart block and 26 cases of sinus arrest associated with regadenoson stress testing were reported via FAERS. 15 In a recent meta-analysis, the incidence of overall and high-grade AV block-defined as secondand third-degree AV block-related to the administration of regadenoson at the dose given during MPI was low (less than 0.5%) and observed much less frequently with regadenoson compared to adenosine (incidence of de novo overall AV block with adenosine was 8.58%; 95% CI 5.55% to 12.21% vs. regadenoson which was 0.30%; 95% CI 0.04% to 0.82%, P \ 0.001, OR 30.6; 95% CI 11.0 to 85.3; incidence of high-grade AV block for adenosine was 5.21%; 95% CI 2.81%-8.30% vs regadenoson which was 0.05%; 95% CI \ 0.001%-0.19%, P \ 0.001, OR 77.2; 95% CI 20.3 to 293.0) (Figure 1).…”

A History of Nuclear Cardiology in the UK

“…They later extended this to adenosine stress [ 8 ], which effectively replaced dipyridamole in the UK because of its shorter half-life and hence safety and practicality. They were also the fi rst group in Europe to use the more specifi c A2a adenosine receptor agonist, regadenoson [ 9 ], which extended the options for stressing patients with obstructive airways disease and potentially also those with conducting tissue disease.…”