Safety and tolerability of regadenoson in comparison with adenosine stress cardiovascular magnetic resonance: Data from a multicentre prospective registry

Menadas, J V Monmeneu; González, María Purificación; López‐Lereu, María P.; Ortega, Laura Higueras; González, Alicia

doi:10.1007/s10554-021-02363-4

Cited by 8 publications

(6 citation statements)

References 45 publications

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“…We also consider that the systematic use of euphylline in all patients may have contributed to better tolerability of the vasodilator. In line with the study by Monmeneu Menadas et al [ 29 ] in our cohort patients with asthma or COPD (n = 96) presented a similar safety profile as the general population, showing no significant adverse events. This observation highlights the safety and tolerability of regadenoson in patients with chronic pulmonary disease.…”

Section: Discussionsupporting

confidence: 92%

“…However, the incidence of symptoms related to the administration of regadenoson varies between the publications. For example, in our study we observed a lower incidence of minor symptoms compared to studies that used nuclear medicine imaging techniques [ 8 , 9 ] but higher than that reported, for example, by a recent CMR study [ 29 ]. Rather than the imaging techniques that were employed, we believe that a more plausible explanation for this finding is the way in which symptoms were reported and collected.…”

Section: Discussioncontrasting

confidence: 69%

“…The administration of this drug presents, however, some limitations, including the need of an MRI-compatible infusion pump, patient weight based dosage calculation, and the relative contraindications in certain subgroup of patients, such as those with severe respiratory disorders (asthma, chronic obstructive pulmonary disease). Regadenoson may help overcome most of these limitations [ 12 – 14 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

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Safety, feasibility, and hemodynamic response of regadenoson for stress perfusion CMR

Muñiz-Sáenz-Diez,

Ezponda,

Caballeros

et al. 2023

Int J Cardiovasc Imaging

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Owing to its pharmacodynamics and posology, the use of regadenoson for stress cardiac magnetic resonance (CMR) has potential advantages over other vasodilators. We sought to evaluate the safety, hemodynamic response and diagnostic performance of regadenoson stress-CMR in routine clinical practice. All regadenoson stress-CMR examinations performed between May 2017 and July 2020 at our institution were retrospectively reviewed. A total of 698 studies were included for the final analysis. A conventional stress/rest protocol was performed using a 1.5T MRI scanner (Magnetom Aera, Siemens Healthineers, Erlangen, Germany). Adverse events, clinical symptoms, and hemodynamic response were assessed. Diagnostic accuracy of the test was evaluated in patients who underwent invasive coronary angiography. Nearly half of patients (48.5%) remained asymptomatic. Most common clinical symptoms included dyspnea (137, 19.6%), chest pain (116, 16.6%) and flushing (44, 6.3%). Two patients (0.28%) could not complete the examination due to severe hypotension or unbearable chest pain. Overall, an increase in heart rate (HR) response (36.2% [IQR: 22.5?50.9]) and a decrease in systolic and diastolic blood pressure (BP) (median systolic BP response of -5% [IQR: -11.5-0.6]; median diastolic BP response of -6.3 mmHg [IQR: -13.4-0]) was observed. Patients with symptoms induced by regadenoson showed higher HR response (40.3%, IQR: 26.4?56.1 vs. 32.4%, IQR: 19-45.6, p < 0.001), whereas a blunted HR response was observed in diabetic (29.6%, IQR: 18.4?42 p < 0.001), obese (31.7%, IQR: 20.7?46.2 p = 0.005) and patients aged 70 years or older (32.9%, IQR: 22.6?43.1 p < 0.001). Overall, regadenoson stress-CMR showed 95.65% (IQ 91.49?99.81) sensitivity, 54.84% (IQ 35.71?73.97) specificity, 86.99% (IQ 82.74?94.68) positive predictive value, and 77.27% (IQ 57.49?97.06) negative predictive value for detecting significant coronary stenosis as compared with invasive coronary angiography. Regadenoson is a well-tolerated vasodilator that can be safely employed for stress perfusion CMR, with high diagnostic performance.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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Safety, feasibility, and hemodynamic response of regadenoson for stress perfusion CMR

Muñiz-Sáenz-Diez,

Ezponda,

Caballeros

et al. 2023

Int J Cardiovasc Imaging

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“…Furthermore, regadenoson has shown higher tolerability and a more favorable side effect profile, particularly for patients with reactive airway disease. 8,9 The widespread use of regadenoson and the clinical importance of CFR warrant consideration of the timing of stress imaging. Stress imaging prior to or after peak hyperemia is reached may result in an underestimation of CFR, confounding care for patients with suspected microvascular disease.…”

Section: Introductionmentioning

confidence: 99%

Timing of Regadenoson-induced Peak Hyperemia and the Effects on Coronary Flow Reserve

Kattapuram,

Shadman,

Morgan

et al. 2024

Preprint

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Background: Regadenoson is used to induce hyperemia in cardiac imaging, facilitating diagnosis of ischemia and assessment of coronary flow reserve (CFR). While the regadenoson package insert recommends administration of radionuclide tracer 10-20 seconds after injection, peak hyperemia has been observed at approximately 100 seconds after injection in healthy volunteers undergoing cardiovascular magnetic resonance imaging (CMR). It is unclear when peak hyperemia occurs in a patient population. Objectives: The goal of this study was to determine time to peak hyperemia after regadenoson injection in healthy volunteers and patients, and whether the recommended image timing in the package insert underestimates CFR. Methods: Healthy volunteers (n=15) and patients (n=25) underwent stress CMR, including phase-contrast imaging of the coronary sinus at rest and multiple timepoints after 0.4 mg regadenoson injection. Coronary sinus flow (ml/min) was divided by resting values to yield CFR. Smoothed, time-resolved curves for CFR were generated with pointwise 95% confidence intervals. Results: CFR between 60 and 120 seconds was significantly higher than CFR at 30 seconds after regadenoson injection (p < 0.05) as shown by non-overlapping 95% confidence intervals for both healthy volunteers (30 s, [2.8, 3.4]; 60 s, [3.8, 4.4]; 90 s, [4.1, 4.7]; 120 s, [3.6, 4.3]) and patients (30 s, [2.1, 2.5]; 60 s, [2.6, 3.1]; 90 s, [2.7, 3.2]; 120 s, [2.5, 3.1]). Conclusion: Imaging at 90 seconds following regadenoson injection is the optimal approach to capture peak hyperemia. Imaging at 30 seconds, which is more aligned with the package insert recommendation, would yield an underestimate of CFR and confound assessment of microvascular dysfunction.

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“…adenosine) is an established diagnostic modality recommended by the current guidelines [ 33 , 34 ]. It possesses both a high diagnostic accuracy non-inferior to invasive fractional flow reserve and an excellent safety profile in the general population [ 33 , 35 – 37 ]. Paradoxically, whilst regular exercise generally protects against atherosclerosis, acute exercise is associated with a significant increase in thromboembolic risk for up to 2 h [ 38 ].…”

Section: Introductionmentioning

confidence: 99%

Safety of dobutamine or adenosine stress cardiac magnetic resonance imaging in patients with left ventricular thrombus

Weberling,

Seitz,

Salatzki

et al. 2023

Clin Res Cardiol

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Background Left ventricular (LV) thrombus formation is a common but potentially serious complication, typically occurring after myocardial infarction. Due to perceived high thromboembolic risk and lack of safety data, stress cardiac magnetic resonance (CMR) imaging especially with dobutamine is usually avoided despite its high diagnostic yield. This study aimed to investigate the characteristics, safety and outcome of patients with LV thrombus undergoing dobutamine or vasodilator stress CMR. Methods Patients undergoing stress CMR with concomitant LV thrombus were retrospectively included. Risk factors, comorbidities, and previous embolic events were recorded. Periprocedural safety was assessed for up to 48 h following the examination. Major adverse cardiac events (MACE) 12 months before the diagnosis were compared to 12 months after the exam and between patients and a matched control group. Additionally, patients were followed up for all-cause mortality. Results 95 patients (78 male, 65 ± 10.7 years) were included. Among them, 43 patients underwent dobutamine (36 high-dose, 7 low-dose) and 52 vasodilator stress CMR. Periprocedural safety was excellent with no adverse events. During a period of 24 months, 27 MACE (14.7%) occurred in patients and controls with no statistical difference between groups. During a median follow-up of 33.7 months (IQR 37.6 months), 6 deaths (6.3%) occurred. Type of stress agent, thrombus mobility, or protrusion were not correlated to embolic events or death. Conclusion The addition of a stress test to a CMR exam is safe and does increase the generally high cardioembolic event rate in LV thrombus patients. Therefore, it is useful to support reperfusion decision-making. Graphical Abstract

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Safety and tolerability of regadenoson in comparison with adenosine stress cardiovascular magnetic resonance: Data from a multicentre prospective registry

Cited by 8 publications

References 45 publications

Safety, feasibility, and hemodynamic response of regadenoson for stress perfusion CMR

Safety, feasibility, and hemodynamic response of regadenoson for stress perfusion CMR

Timing of Regadenoson-induced Peak Hyperemia and the Effects on Coronary Flow Reserve

Safety of dobutamine or adenosine stress cardiac magnetic resonance imaging in patients with left ventricular thrombus

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