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Muñiz-Sáenz-Diez J, Ezponda A, Caballeros M, de la Fuente A, Gavira JJ, Bastarrika G. Safety, feasibility, and hemodynamic response of regadenoson for stress perfusion CMR. Int J Cardiovasc Imaging 2023; 39:1765-1774. [PMID: 37354385 PMCID: PMC10520095 DOI: 10.1007/s10554-023-02877-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/15/2023] [Indexed: 06/26/2023]
Abstract
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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Affiliation(s)
- Javier Muñiz-Sáenz-Diez
- Department of Cardiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, 31007, Spain.
| | - Ana Ezponda
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Meylin Caballeros
- Department of Radiology, Clínica Universidad de Navarra, Madrid, Spain
| | - Ana de la Fuente
- Department of Cardiology, Clínica Universidad de Navarra, Madrid, Spain
| | - Juan J Gavira
- Department of Cardiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, 31007, Spain
| | - Gorka Bastarrika
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
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Nguyen KL, Bandettini WP, Shanbhag S, Leung SW, Wilson JR, Arai AE. Safety and tolerability of regadenoson CMR. Eur Heart J Cardiovasc Imaging 2014; 15:753-60. [PMID: 24451179 PMCID: PMC4060784 DOI: 10.1093/ehjci/jet278] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Knowledge 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 METHODS A 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. RESULTS There 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/m(2) (P < 0.001), and diabetes (P = 0.001). CONCLUSIONS Regadenoson CMR is well tolerated and can be performed safely with few adverse events.
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Affiliation(s)
- Kim-Lien Nguyen
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90073, USA
| | - W Patricia Bandettini
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA
| | - Sujata Shanbhag
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA
| | - Steve W Leung
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Joel R Wilson
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA Division of Cardiovascular Medicine, University of California, San Diego, San Diego, CA 92103, USA
| | - Andrew E Arai
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, National Institutes of Health, 10 Center Drive Bldg 10, Rm B1D416, MSC 1061, Bethesda, MD 20892-1061, USA
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Khoo JP, Grundy BJ, Steadman CD, Sonnex EP, Coulden RA, McCann GP. Stress cardiovascular MR in routine clinical practice: referral patterns, accuracy, tolerance, safety and incidental findings. Br J Radiol 2012; 85:e851-7. [PMID: 22457320 DOI: 10.1259/bjr/14829242] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The use of stress cardiovascular MR (CMR) to evaluate myocardial ischaemia has increased significantly over recent years. We aimed to assess the indications, incidental findings, tolerance, safety and accuracy of stress CMR in routine clinical practice. METHODS We retrospectively examined all stress CMR studies performed at our tertiary referral centre over a 20-month period. Patients were scanned at 1.5 T, using a standardised protocol with routine imaging for late gadolinium enhancement. Angiograms of patients were assessed by an interventional cardiologist blinded to the CMR data. RESULTS 654 patients were scanned (mean age 65±29 years; 63 inpatients; 9.6%). 14% of patients had incidental extracardiac findings, the commonest being liver or renal cysts (6%) and pulmonary nodules (4%). 639 patients (97.7%) received intravenous adenosine, 10 received intravenous dobutamine and 5 patients had both. Of the 15 patients who received dobutamine, 12 had no side-effects/complications, 2 experienced nausea and 1 chest tightness. Of the 644 patients who received adenosine, 43% experienced minor symptoms, 1% had transient heart block and 0.2% had severe bronchospasm requiring termination of infusion. There were no cases of hospitalisation or myocardial infarction. 241 patients also had coronary angiography. For detecting at least moderate stenosis of ≥50%, sensitivity was 86%, specificity 98% and accuracy 89%. For detecting severe stenoses of ≥70%, sensitivity was 91%, specificity 86% and overall accuracy 90%. These results compare very favourably with previous smaller research studies and meta-analyses. CONCLUSION We conclude that stress CMR, with adenosine as the main stress agent, is well tolerated, safe and accurate in routine clinical practice.
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Affiliation(s)
- J P Khoo
- Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
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Karamitsos TD, Arnold JR, Pegg TJ, Cheng ASH, van Gaal WJ, Francis JM, Banning AP, Neubauer S, Selvanayagam JB. Tolerance and safety of adenosine stress perfusion cardiovascular magnetic resonance imaging in patients with severe coronary artery disease. Int J Cardiovasc Imaging 2008; 25:277-83. [DOI: 10.1007/s10554-008-9392-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 11/10/2008] [Indexed: 11/28/2022]
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Pilz G, Bernhardt P, Harrer E, Klos M, Höfling B. Cardiac magnetic resonance imaging: an essential diagnostic aid in suspected myocardial re-infarction in a 40 year old woman. Clin Res Cardiol 2008; 97:280-3. [PMID: 18193372 DOI: 10.1007/s00392-007-0632-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 11/23/2007] [Indexed: 11/29/2022]
Affiliation(s)
- Günter Pilz
- Dept. of Cardiology, Clinic Agatharied, Academic Teaching Hospital, University of Munich, St.-Agatha-Str. 1, 83734 Hausham, Germany.
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