Safety of regadenoson as a pharmacologic stress agent for myocardial perfusion imaging in chronic kidney disease patients not on hemodialysis

Palani, Gurunanthan; Husain, Zehra; Salinas, Rafael Cabrera; Karthikeyan, Vanji; Karthikeyan, Aarthee S.; Ananthasubramaniam, Karthik

doi:10.1007/s12350-011-9378-8

Cited by 28 publications

(9 citation statements)

References 22 publications

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“…Another open question is whether the increase in A 2A -ARs is the cause or the results of atrial fibrillation in humans. A 2A -AR activation is used in the clinic to assess the vasodilatory capability of coronary arteries for nuclear magnetic studies (Palani et al, 2011). Moreover, adenosine is used to treat supraventricular arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Evidence for Arrhythmogenic Effects of A2A-Adenosine Receptors

et al. 2019

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Adenosine can be released from the heart and may stimulate four different cardiac adenosine receptors. A receptor subtype that couples to the generation of cyclic adenosine monophosphate (cAMP) is the A2A-adenosine receptor (A2A-AR). To better understand its role in cardiac function, we studied mechanical and electrophysiological effects in transgenic mice that overexpress the human A2A-AR in cardiomyocytes (A2A-TG). We used isolated preparations from the left atrium, the right atrium, isolated perfused hearts with surface electrocardiogram (ECG) recording, and surface body ECG recordings of living mice. The hypothesized arrhythmogenic effects of transgenicity per se and A2A-AR stimulation were studied. We noted an increase in the incidence of supraventricular and ventricular arrhythmias under these conditions in A2A-TG. Moreover, we noted that the A2A-AR agonist CGS 21680 exerted positive inotropic effect in isolated human electrically driven (1 Hz) right atrial trabeculae carneae. We conclude that A2A-ARs are functional not only in A2A-TG but also in isolated human atrial preparations. A2A-ARs in A2A-TG per se and their stimulation can lead to cardiac arrhythmias not only in isolated cardiac preparations from A2A-TG but also in living A2A-TG.

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Section: Discussionmentioning

confidence: 99%

Evidence for Arrhythmogenic Effects of A2A-Adenosine Receptors

et al. 2019

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“…2–4 Regadenoson is also safe in patients with stage 3–4 renal failure, 5,6 end-stage liver disease, 7 post-cardiac transplant, 8 chronic obstructive pulmonary disease (COPD) and mild-to-moderate asthma. 9,10 However, there is a paucity of data to address the safety and tolerability of regadenoson in perfusion CMR, 11,12 where ECG monitoring is less reliable due to magnetohydrodynamic effects 13 and resuscitation necessitates prompt removal of the patient from the scanner.…”

Section: Introductionmentioning

confidence: 99%

Safety and tolerability of regadenoson CMR

Nguyen

Bandettini

Shanbhag

et al. 2014

European Heart Journal - Cardiovascular Imaging

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AimsKnowledge of adverse events associated with regadenoson perfusion cardiac magnetic resonance (CMR) and patient tolerability has implications for patient safety and staff training. We sought to assess the safety and tolerability of regadenoson stress CMR.Materials and methodsA group of 728 consecutive patients (median age 58, 44% female) and 25 normal volunteers (median age 21, 24% female) were recruited from August 2009 to March 2012 using a prospective, cross-sectional study design. Subjects were stressed using fixed-dose regadenoson and imaged using a 1.5T MRI scanner. Symptoms and adverse events including death, myocardial infarction (MI), ventricular tachycardia (VT)/ventricular fibrillation (VF), hospitalization, arrhythmias, and haemodynamic stability were assessed.ResultsThere were no occurrences of death, MI, VT/VF, high-grade atrioventricular block, or stress-induced atrial fibrillation. Notable adverse events included one case of bronchospasm and one case of heart failure exacerbation resulting in hospitalization. The most common symptoms in patients were dyspnoea (30%, n = 217), chest discomfort (27%, n = 200), and headache (15%, n = 111). There was minimal change between baseline and peak systolic and diastolic blood pressure in both patients and volunteers (P > 0.05). A blunted heart rate response to regadenoson was noted in patients with body mass index (BMI) ≥30 kg/m2 (P < 0.001), and diabetes (P = 0.001).ConclusionsRegadenoson CMR is well tolerated and can be performed safely with few adverse events.

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“…Although our patient had underlying renal insufficiency, and there have been some studies to suggest increased incidence of side effects among chronic kidney disease patients after the administration of regadenoson, clinical studies have established the safety of regadenoson in this group of patients not on dialysis (GFR b 60 ml/min) [5] with minimal additional side effects and a favorable hemodynamic response [5][6][7][8]. On the basis of currently available data, regadenoson can be safely used in patients with underlying chronic kidney disease.…”

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confidence: 87%