WJCD  Vol.3 No.2 , April 2013
Can regadenoson pharmacologic SPECT be performed effectively in patients with left bundle branch block or paced rhythm patients? A retrospective comparison to adenosine SPECT
ABSTRACT

Purpose: Regadenoson (REG) is currently becoming the stress agent of choice in patients undergoing pharmacologic single photon emission computed tomography (SPECT). However, in patients with left bundle branch block (LBBB) and ventricular paced rhythm (VPR), hesitation exists amongst clinicians to use REG-SPECT due to the concern that the increased heart rate could cause false positive SPECT results. We sought to evaluate the comparability of A-SPECT and REG-SPECT in patients with LBBB and VPR. Methods: Retrospective study of 30 patients who served as their own controls. All 30 patients who underwent REG-SPECT (Grp 1) were compared to their prior A-SPECT (Grp 2) done within two years prior to REG-SPECT. Heart rate (HR) and blood pressure (BP) parameters, ECG, stress perfusion and gated variables, SPECT ischemia, and side-effects were evaluated. Statistical significance was set at P < 0.05. Results: Grp 1 and Grp 2 were comparable in hemodynamic parameters with increase in HR and decrease in systolic and diastolic BP with administration of adenosine and REG stress agents. However, there were no significant differences found in hemodynamic parameters and II degree AV block between the groups. All normal A-SPECT were found to be normal with REG-SPECT. No differences could be found between the two groups among SPECT parameters. Muscle pain was significantly higher in REG (10.0% vs. 0.0%, P = 0.083) and so was the use of aminophylline (16.7% vs. 0.0%, P = 0.025) to relieve the side-effect. Conclusion: REG-SPECT can be administered in patients with LBBB and VPR patients based on favorable and comparable hemodynamic responses and arrhythmia occurrences to A-SPECT. REG-SPECT can also be used for adequate interpretation of presence or absence of SPECT ischemia particularly in the LAD territory without any concern for false positive perfusion defects.


Cite this paper
Palani, G. , Karthikeyan, A. , Gordon, J. and Ananthasubramaniam, K. (2013) Can regadenoson pharmacologic SPECT be performed effectively in patients with left bundle branch block or paced rhythm patients? A retrospective comparison to adenosine SPECT. World Journal of Cardiovascular Diseases, 3, 222-227. doi: 10.4236/wjcd.2013.32034.
References
[1]   Rosamond, W., Flegal, K., Furie, K., Go, A., Greenlund, K., Haase, N., Hailpern, S.M., Ho, M., Howard, V., Kissela, B., Kittner, S., Lloyd-Jones, D., McDermott, M., Meigs, J., Moy, C., Nichol, G., O’Donnell, C., Roger, V., Sorlie, P., Steinberger, J., Thom, T., Wilson, M. and Hong, Y. (2008) Heart disease and stroke statistics—2008 update: A report from the American heart association statistics committee and stroke statistics subcommittee. Circulation, 117, e25-e146. doi:10.1161/CIRCULATIONAHA.107.187998

[2]   Hardarson, T., Arnason, A., Eliasson, G. J., Palsson, K., Eyjolfsson, K. and Sigfusson, N. (1987) Left bundle branch block: Prevalence, incidence, follow-up and outcome. European Heart Journal, 8, 1075-1079.

[3]   Ono, S., Nohara, R., Kambara, H., Okuda, K. and Kawai, C. (1992) Regional myocardial perfusion and glucose metabolism in experimental left bundle branch block. Circulation, 85, 1125-1131. doi:10.1161/01.CIR.85.3.1125

[4]   O’Keefe Jr., J.H., Bateman, T.M. and Barnhart, C.S. (1993) Adenosine thallium-201 is superior to exercise thallium-201 for detecting coronary artery disease in patients with left bundle branch block. Journal of the American College of Cardiology, 21, 1332-1338. doi:10.1016/0735-1097(93)90305-K

[5]   Morais, J., Soucy, J.P., Sestier, F., Lamoureux, F., Lamoureux, J. and Danais, S. (1990) Dipyridamole testing compared to exercise stress for thallium-201 imaging in patients with left bundle branch block. Canadian Journal of Cardiology, 6, 5-8.

[6]   Garnock-Jones, K.P. and Curran, M.P. (2010) Regadenoson. American Journal of Cardiovascular Drugs, 10, 65-71. doi:10.2165/10489040-000000000-00000

[7]   Cerqueira, M.D., Nguyen, P., Staehr, P., Underwood, S.R. and Iskandrian, A.E. (2008) Effects of age, gender, obesity, and diabetes on the efficacy and safety of the selective a2a agonist regadenoson versus adenosine in myocardial perfusion imaging integrated advance-mpi trial results. JACC: Cardiovascular Imaging, 1, 307-316. doi:10.1016/j.jcmg.2008.02.003

[8]   Mahmarian, J.J., Cerqueira, M.D., Iskandrian, A.E., Bateman, T.M., Thomas, G.S., Hendel, R.C., Moye, L.A. and Olmsted, A.W. (2009) Regadenoson induces comparable left ventricular perfusion defects as adenosine: A quantitative analysis from the advance mpi 2 trial. JACC: Cardiovascular Imaging, 2, 959-968. doi:10.1016/j.jcmg.2009.04.011

[9]   Iskandrian, A.E., Bateman, T.M., Belardinelli, L., Blackburn, B., Cerqueira, M.D., Hendel, R.C., Lieu, H., Mahmarian, J.J., Olmsted, A., Underwood, S.R., Vitola, J. and Wang, W. (2007) Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the advance phase 3 multicenter international trial. Journal of Nuclear Cardiology, 14, 645-658. doi:10.1016/j.nuclcard.2007.06.114

[10]   Cerqueira, M.D. (2004) The future of pharmacologic stress: Selective a2a adenosine receptor agonists. American Journal of Cardiovascular Drugs, 94, 33D-42D.

[11]   Gao, Z., Li, Z., Baker, S.P., Lasley, R.D., Meyer, S., Elzein, E., Palle, V., Zablocki, J.A., Blackburn, B. and Belardinelli, L. (2001) Novel short-acting a2a adenosine receptor agonists for coronary vasodilation: Inverse relationship between affinity and duration of action of a2a agonists. Journal of Pharmacology and Experimental Therapeutics, 298, 209-218.

[12]   Lexiscan (regadenoson) injection. Deerfield IAPU, Inc.

[13]   Fleisher, L.A., Beckman, J.A., Brown, K.A., Calkins, H., Chaikof, E., Fleischmann, K.E., Freeman, W.K., Froehlich, J.B., Kasper, E.K., Kersten, J.R., Riegel, B., Robb, J.F., Smith Jr., S.C., Jacobs, A.K., Adams, C.D., Anderson, J.L., Antman, E.M., Buller, C.E., Creager, M.A., Ettinger, S.M., Faxon, D.P., Fuster, V., Halperin, J.L., Hiratzka, L.F., Hunt, S.A., Lytle, B.W., Nishimura, R., Ornato, J.P., Page, R.L., Tarkington, L.G. and Yancy, C.W. (2008) ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: Executive summary: A report of the american college of cardiology/american heart association task force on practice guidelines (writing committee to revise the 2002 guidelines on perioperative cardiovascular evaluation for noncardiac surgery). Anesthesia & Analgesia, 106, 685712. doi:10.1213/01/ane.0000309024.28586.70

[14]   Hansen, C.L., Goldstein, R.A., Akinboboye, O.O., Berman, D.S., Botvinick, E.H., Churchwell, K.B., Cooke, C.D., Corbett, J.R., Cullom, S.J., Dahlberg, S.T., Druz, R.S., Ficaro, E.P., Galt, J.R., Garg, R.K., Germano, G., Heller, G.V., Henzlova, M.J., Hyun, M.C., Johnson, L.L., Mann, A., McCallister Jr., B.D., Quaife, R.A., Ruddy, T.D., Sundaram, S.N., Taillefer, R., Ward, R.P. and Mahmarian, J.J. (2007) Myocardial perfusion and function: Single photon emission computed tomography. Journal of Nuclear Cardiology, 14, e39-e60. doi:10.1016/j.nuclcard.2007.09.023

[15]   Jazmati, B., Sadaniantz, A., Emaus, S.P. and Heller, G.V. (1991) Exercise thallium-201 imaging in complete left bundle branch block and the prevalence of septal perfusion defects. The American Journal of Cardiology, 67, 46-49. doi:10.1016/0002-9149(91)90097-5

[16]   Vaduganathan, P., He, Z.X., Mahmarian, J.J. and Verani, M.S. (1998) Diagnostic accuracy of stress thallium-201 tomography in patients with left ventricular hypertrophy. The American Journal of Cardiology, 81, 1205-1207. doi:10.1016/S0002-9149(98)00091-5

[17]   Lieu, H.D., Shryock, J.C., von Mering, G.O., Gordi, T., Blackburn, B., Olmsted, A.W., Belardinelli, L. and Kerensky, R.A. (2007) Regadenoson, a selective a2a adenosine receptor agonist, causes dose-dependent increases in coronary blood flow velocity in humans. Journal of Nuclear Cardiology, 14, 514-520. doi:10.1016/j.nuclcard.2007.02.016

[18]   Gordi, T., Frohna, P., Sun, H.L., Wolff, A., Belardinelli, L. and Lieu, H. (2006) A population pharmacokinetic/ pharmacodynamic analysis of regadenoson, an adenosine a2a-receptor agonist, in healthy male volunteers. Clinical Pharmacokinetics, 45, 1201-1212. doi:10.2165/00003088-200645120-00005

[19]   Aljaroudi, W., Hermann, D., Hage, F., Heo, J. and Iskandrian, A.E. (2010) Safety of regadenoson in patients with end-stage renal disease. The American Journal of Cardiology, 105, 133-135. doi:10.1016/j.amjcard.2009.08.663

 
 
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