Regadenoson Versus Dipyridamole: Evaluation of Stress Myocardial Blood Flow Response on a CZT-SPECT Camera

Overview

Journal J Nucl Cardiol

Specialty Cardiology & Vascular Diseases

Date 2020 Jul 12

PMID 32651801

Citations 9

Authors

Quentin Brana

Frederique Thibault

Maxime Courtehoux

Gilles Metrard

Maria Joao Ribeiro

Denis Angoulvant

Matthieu Bailly

Affiliations

Soon will be listed here.

Abstract

Background: Regadenoson is a selective adenosine receptor agonist. It is currently unclear if the level of hyperemia differs between stress agents. We compared Myocardial Blood Flow (MBF) and Myocardial Flow Reserve (MFR) response on CZT-SPECT Myocardial Perfusion Imaging (MPI) to evaluate if dipyridamole and regadenoson could induce the same level of hyperemia.

Methods: 228 patients with dynamic CZT-SPECT MPI were retrospectively analyzed (66 patients stressed with regadenoson and 162 with dipyridamole) in terms of MBF and MFR. To rule out confounding factors, two groups of 41 patients were matched for clinical characteristics in a sub-analysis, excluding high cardiovascular risk patients.

Results: Overall stress MBF was higher in regadenoson patients (1.71 ± 0.73 vs. 1.44 ± 0.55 mL·min·g for regadenoson and dipyridamole, respectively, p < .05). However, when confounding factors were ruled out, stress MBF (1.57 ± 0.56 vs. 1.61 ± 0.62 mL·min·g for dipyridamole and regadenoson, respectively, p = .88) and MFR (2.62 ± 0.77 vs. 2.46 ± 0.76 for dipyridamole and regadenoson, respectively, p = .40) were not different between regadenoson and dipyridamole.

Conclusions: Our results suggest that dipyridamole and regadenoson induce equivalent hyperemia in dynamic SPECT with similar stress MBF and MFR in comparable patients.

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References

Johnson S, Peters S . Advances in pharmacologic stress agents: focus on regadenoson. J Nucl Med Technol. 2010; 38(3):163-71. DOI: 10.2967/jnmt.109.065581. View

Leaker B, OConnor B, Hansel T, Barnes P, Meng L, Mathur V . Safety of regadenoson, an adenosine A2A receptor agonist for myocardial perfusion imaging, in mild asthma and moderate asthma patients: a randomized, double-blind, placebo-controlled trial. J Nucl Cardiol. 2008; 15(3):329-36. DOI: 10.1016/j.nuclcard.2008.02.009. View

Page 2nd R, Spurck P, Bainbridge J, Michalek J, Quaife R . Seizures associated with regadenoson: a case series. J Nucl Cardiol. 2011; 19(2):389-91. DOI: 10.1007/s12350-011-9461-1. View

Druz R . Current advances in vasodilator pharmacological stress perfusion imaging. Semin Nucl Med. 2009; 39(3):204-9. DOI: 10.1053/j.semnuclmed.2008.12.003. View

Iskandrian A, Bateman T, Belardinelli L, Blackburn B, Cerqueira M, Hendel R . Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol. 2007; 14(5):645-58. DOI: 10.1016/j.nuclcard.2007.06.114. View

Mahmarian J, Cerqueira M, Iskandrian A, Bateman T, Thomas G, Hendel R . Regadenoson induces comparable left ventricular perfusion defects as adenosine: a quantitative analysis from the ADVANCE MPI 2 trial. JACC Cardiovasc Imaging. 2009; 2(8):959-68. DOI: 10.1016/j.jcmg.2009.04.011. View

Mahmarian J, Peterson L, Xu J, Cerqueira M, Iskandrian A, Bateman T . Regadenoson provides perfusion results comparable to adenosine in heterogeneous patient populations: a quantitative analysis from the ADVANCE MPI trials. J Nucl Cardiol. 2014; 22(2):248-61. DOI: 10.1007/s12350-014-9981-6. View

Cerqueira M, Nguyen P, Staehr P, Underwood S, Iskandrian A . 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 Cardiovasc Imaging. 2009; 1(3):307-16. DOI: 10.1016/j.jcmg.2008.02.003. View

Iqbal F, Hage F, Ahmed A, Dean P, Raslan S, Heo J . Comparison of the prognostic value of normal regadenoson with normal adenosine myocardial perfusion imaging with propensity score matching. JACC Cardiovasc Imaging. 2012; 5(10):1014-21. DOI: 10.1016/j.jcmg.2012.04.009. View

10.

Golzar Y, Doukky R . Regadenoson use in patients with chronic obstructive pulmonary disease: the state of current knowledge. Int J Chron Obstruct Pulmon Dis. 2014; 9:129-37. PMC: 3904829. DOI: 10.2147/COPD.S56879. View

11.

Hussain N, Chaudhry W, Ahlberg A, Amara R, Elfar A, Parker M . An assessment of the safety, hemodynamic response, and diagnostic accuracy of commonly used vasodilator stressors in patients with severe aortic stenosis. J Nucl Cardiol. 2016; 24(4):1200-1213. DOI: 10.1007/s12350-016-0427-1. View

12.

Rai M, Ahlberg A, Marwell J, Chaudhary W, Savino 3rd J, Alter E . Safety of vasodilator stress myocardial perfusion imaging in patients with elevated cardiac biomarkers. J Nucl Cardiol. 2016; 24(2):724-734. DOI: 10.1007/s12350-016-0448-9. View

13.

Gupta A, Bajaj N . Regadenoson use for stress myocardial perfusion imaging in advance chronic kidney disease and dialysis: Safe, effective, and efficient. J Nucl Cardiol. 2017; 25(1):150-152. PMC: 5802370. DOI: 10.1007/s12350-017-1038-1. View

14.

Camici P, Rimoldi O . The clinical value of myocardial blood flow measurement. J Nucl Med. 2009; 50(7):1076-87. DOI: 10.2967/jnumed.108.054478. View

15.

Nkoulou R, Fuchs T, Pazhenkottil A, Kuest S, Ghadri J, Stehli J . Absolute Myocardial Blood Flow and Flow Reserve Assessed by Gated SPECT with Cadmium-Zinc-Telluride Detectors Using 99mTc-Tetrofosmin: Head-to-Head Comparison with 13N-Ammonia PET. J Nucl Med. 2016; 57(12):1887-1892. DOI: 10.2967/jnumed.115.165498. View

16.

Agostini D, Roule V, Nganoa C, Roth N, Baavour R, Parienti J . First validation of myocardial flow reserve assessed by dynamic Tc-sestamibi CZT-SPECT camera: head to head comparison with O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study. Eur J Nucl Med Mol Imaging. 2018; 45(7):1079-1090. PMC: 5953996. DOI: 10.1007/s00259-018-3958-7. View

17.

Giubbini R, Bertoli M, Durmo R, Bonacina M, Peli A, Faggiano I . Comparison between NNH-PET and Tc-Tetrofosmin-CZT SPECT in the evaluation of absolute myocardial blood flow and flow reserve. J Nucl Cardiol. 2019; 28(5):1906-1918. DOI: 10.1007/s12350-019-01939-x. View

18.

Mannarino T, Gaudieri V, Acampa W . Vasodilators and myocardial blood flow by CZT cameras: Make us see further. J Nucl Cardiol. 2020; 29(1):123-125. DOI: 10.1007/s12350-020-02369-w. View

19.

Goudarzi B, Fukushima K, Bravo P, Merrill J, Bengel F . Comparison of the myocardial blood flow response to regadenoson and dipyridamole: a quantitative analysis in patients referred for clinical 82Rb myocardial perfusion PET. Eur J Nucl Med Mol Imaging. 2011; 38(10):1908-16. DOI: 10.1007/s00259-011-1853-6. View

20.

Bravo P, Pozios I, Pinheiro A, Merrill J, Tsui B, Wahl R . Comparison and effectiveness of regadenoson versus dipyridamole on stress electrocardiographic changes during positron emission tomography evaluation of patients with hypertrophic cardiomyopathy. Am J Cardiol. 2012; 110(7):1033-9. PMC: 3439569. DOI: 10.1016/j.amjcard.2012.05.038. View