RAPISCAN
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    RAPISCAN

    Regadenosón

    Cardiología (Estrés Farmacológico)

    Rapiscan es un vasodilatador coronario indicado en pruebas de esfuerzo farmacológicas para realizar estudios de imagen de perfusión miocárdica con radionúclidos en pacientes que no pueden someterse a una adecuada prueba de esfuerzo con ejercicio.1 

    Rapiscan provoca una respuesta hiperémica rápida e idónea, en intensidad y duración.2 Su selectividad sobre los receptores A2A de la adenosina le confiere un buen perfil de seguridad en pacientes con asma y EPOC.3,4 Rapiscan se administra en bolus intravenoso único, independientemente del peso del individuo, lo que se traduce en facilidad de uso, baja probabilidad de errores en la dosificación y acortamiento del tiempo empleado para el protocolo de estrés farmacológico en estudios de imagen de perfusión miocárdica (menos de 1 minuto).1,5,6

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    Información adicional

    Rapiscan se administra en bolus intravenoso único, independientemente del peso del individuo, lo que se traduce en facilidad de uso, baja probabilidad de errores en la dosificación y acortamiento del tiempo empleado para la prueba.1

    Posología

    La dosis recomendada es una inyección única de 400 microgramos de regadenosón (5 ml) en una vena periférica, y no es necesario realizar un ajuste de la dosis en función del peso corporal. Regadenosón causa un incremento rápido de la frecuencia cardíaca.1
    Los pacientes deben permanecer sentados o tumbados y deben ser monitorizados a intervalos frecuentes tras la inyección hasta que los parámetros del ECG, la frecuencia cardíaca y la presión arterial hayan regresado a los niveles previos a la dosificación.1

    Pacientes de edad avanzada

    No es necesario realizar un ajuste de la dosis.1

    Insuficiencia hepática

    No es necesario realizar un ajuste de la dosis.1

    Insuficiencia renal

    No es necesario realizar un ajuste de la dosis.1

    Forma de administración

    Por vía intravenosa.

    • Rapiscan debe administrarse como inyección rápida de 10 segundos en una vena periférica utilizando un catéter o aguja de calibre 22 ó más grandes.
    • Inmediatamente después de la inyección de Rapiscan deben administrarse 5 ml de solución inyectable de cloruro sódico de 9 mg/ml (al 0,9%).
    • El radiofármaco para el estudio de imagen de perfusión miocárdica debe administrarse 10-20 segundos después de la solución inyectable de cloruro sódico de 9 mg/ml (al 0,9%). El radiofármaco puede inyectarse directamente en el mismo catéter con el que se administró Rapiscan.1

     

    Presentaciones

    Rapiscan 400 mcg solución inyectable (CN: 698441.3)

     

    Referencias

    1 Agencia Española de Medicamentos y Productos Sanitarios. Centro de Información online de Medicamentos de la AEMPS. Ficha técnica RAPISCAN® [sede web]. [Actualizado 2015; acceso noviembre 2015].
    Lieu HD, Shryock JC, von Mering GO, Gordi T, Blackburn B, Olmsted AW, et al. Regadenoson, a selective A2A adenosine receptor agonist, causes dose-dependent increases in coronary blood flow velocity in humans. J Nucl Cardiol. 2007;14(4):514-20.
    3 Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE. 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. J Am Coll Cardiol Img. 2008;1:307-16.
    4 Prenner BM, Bukofzer S, Behm S, Feaheny K, McNutt BE. A randomized, double-blind, placebo-controlled study assessing the safety and tolerability of regadenoson in subjects with asthma or chronic obstructive pulmonary disease. J Nucl Cardiol. 2012;19(4):681–692.
    5 Johnson SG, Peters S. Advances in pharmacologic stress agents: focus on regadenoson. J Nucl Med Technol. 2010 Sep;38(3):163-71.
    Friedman M, Spalding J, Kothari S, Wu Y, Gatt E, Boulanger L. Myocardial perfusion imaging laboratory efficiency with the use of regadenoson compared to adenosine and dipyridamole. J Med Econ. 2013;16(4):449-60.

    Myocardial perfusion SPECT 2015 in Germany. Results of the 7th survey
    Myocardial perfusion scintigraphy; numerical data; utilisation review; utilisation statistics.

    AIM: The working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine presents the results of the 7th survey of myocardial perfusion SPECT (MPS) of the reporting year 2015.

    METHOD: 268 questionnaires (173 practices [PR], 67 hospitals [HO], 28 university hospitals [UH]) were evaluated. Results of the last survey from 2012 are set in squared brackets.

    RESULTS: MPS of 121 939 [105 941] patients were reported. 98 % [95 %] of all MPS were performed with Tc-99m radiopharmaceuticals and 2 % [5 %] with Tl-201. 78 % [79 %] of all patients were studied in PR, 14 % [15 %] in HO, and 8 % [6 %] in UH. A pharmacological stress test was performed in 43 % [39 %] (22 % [24 %] adenosine, 20 % [9 %] regadenoson, 1 % [6 %] dipyridamole or dobutamine). Attenuation correction was applied in 25 % [2009: 10 %] of MPS. Gated SPECT was performed in 78 % [70 %] of all rest MPS, in 80 % [73 %] of all stress and in 76 % [67 %] of all stress and rest MPS. 53 % [33 %] of all nuclear medicine departments performed MPS scoring by default, whereas 24 % [41 %] did not apply any quantification. 31 % [26 %] of all departments noticed an increase in their counted MPS and 29 % [29 %] no changes. Data from 89 departments which participated in all surveys showed an increase in MPS count of 11.1 % (PR: 12.2 %, HO: 4.8 %, UH: 18.4 %). 70 % [60 %] of the MPS were requested by ambulatory care cardiologists.

    CONCLUSION: The 2015 MPS survey reveals a high-grade adherence of routine MPS practice to current guidelines. The positive trend in MPS performance and number of MPS already observed in 2012 continues. Educational training remains necessary in the field of SPECT scoring.

    Lindner O, Burchert W, Schäfer W, Hacker M.
    Nuklearmedizin. [Epub ahead of print]
    12/2016
    Safety of regadenoson stress testing in patients with pulmonary hypertension
    Pulmonary hypertension; coronary artery disease; pulmonary arterial hypertension; regadenoson; stress test.

    OBJECTIVES: We sought to determine the safety of regadenoson stress testing in patients with PH.

    BACKGROUNDPH is increasingly recognized at more advanced ages. As many as one-third of patients with PH have coronary artery disease. Because of their physical limitations, patients with PH are unable to adequately exercise. Regadenoson can potentially have an adverse impact due to their tenuous hemodynamics. Current guidelines suggest performing a coronary angiography in patients with PH who have angina or multiple coronary risk factors.

    METHODS: We identified 67 consecutive patients with confirmed PH by catheterization (mean PA > 25 mmHg not due to left heart disease) who underwent MPI with regadenoson stress. Medical records were reviewed to determine hemodynamic and ECG response to regadenoson.

    RESULTS: No serious events occurred. Common side effects related to regadenoson were observed, dyspnea being the most common (70.6%). No syncope occurred. Heart rate increased from 74.6 ± 14 to 96.3 ± 18.3 bpm, systolic blood pressure increased from 129.8 ± 20.9 to 131.8 ± 31 mmHg, and diastolic blood pressure decreased from 77.1 ± 11.4 to 72.9 ± 15.3 mmHg. There was no ventricular tachycardia, ventricular fibrillation, or second- or third-degree atrioventricular block.

    CONCLUSION: Regadenoson stress MPI appears to be well tolerated and safe in patients with PH.

    Moles VM, Cascino T, Saleh A, Mikhova K, Lazarus JJ, Ghannam M, et al.
    J Nucl Cardiol. [Epub ahead of print]
    11/2016
    The impact of combination of regadenoson and isometric exercise on image quality of myocardial perfusion scintigraphy
    Ceyrat Q, Mesguich C, Janvier L, Douard H, Bordenave L, Pinaquy JB.
    J Nucl Cardiol. [Epub ahead of print]
    11/2016
    Influence of hemodialysis on regadenoson clearance in an in vitro hemodialysis model
    Regadenoson; chronic kidney disease (CKD); clearance; hemodialysis.

    BACKGROUND: Regadenoson is a novel pharmacological stress agent whose disposition during hemodialysis is not known. The purpose of this study was to determine the clearance of regadenoson under varying dialytic conditions using an in vitro hemodialysis model.

    METHODS AND RESULTS: Whole human blood was used to analyze the effect of hemodialysis on the clearance of regadenoson. Regadenoson transmembrane clearance (CLD) was assessed for both a standard permeability and a high permeability polysulfone hemodialyzer with blood/dialysate flow rates of 300/600 and 400/800 mL/min. A two-tailed, paired Student's t test was used to compare regadenoson CLD between hemodialyzer types and flow rates. The mean ± SD regadenoson CLD values ranged between 62.5 ± 11.8 and 89.1 ± 24.0 mL/min for all dialytic conditions. There was no significant difference in regadenoson CLD between hemodialyzer types and flow rates (p > .05).

    CONCLUSIONS: Hemodialysis enhances the clearance of regadenoson independent of hemodialyzer permeability and blood/dialysate flow rate. This clearance is modest relative to total body clearance and is unlikely to produce a clinically significant outcome.

    Gharibian KN, Murthy VL, Mueller BA.
    J Nucl Cardiol. [Epub ahead of print]
    01/2016
    Quantitation of left ventricular ejection fraction reserve from early gated regadenoson stress Tc-99m high-efficiency SPECT
    Regadenoson Tc-99m high-efficiency SPECT; early stress imaging; image quality; left ventricular ejection fraction reserve.

    ​BACKGROUND: Ejection fraction (EF) reserve has been found to be a useful adjunct for identifying high risk coronary artery disease in cardiac positron emission tomography (PET). We aimed to evaluate EF reserve obtained from technetium-99m sestamibi (Tc-99m) high-efficiency (HE) SPECT.

    METHODSFifty patients (mean age 69 years) undergoing regadenoson same-day rest (8-11 mCi)/stress (32-42 mCi) Tc-99m gated HE SPECT were enrolled. Stress imaging was started 1 minute after sequential intravenous regadenoson .4 mg and Tc-99m injections, and was composed of five 2 minutes supine gated acquisitions followed by two 4 minutes supine and upright images. Ischemic total perfusion deficit (ITPD) ≥5 % was considered as significant ischemia.

    RESULTS: Significantly lower mean EF reserve was obtained in the 5th and 9th minute after regadenoson bolus in patients with significant ischemia vs patients without (5th minute: -4.2 ± 4.6% vs 1.3 ± 6.6%, P = .006; 9th minute: -2.7 ± 4.8% vs 2.0 ± 6.6%, P = .03).

    CONCLUSIONS: Negative EF reserve obtained between 5th and 9th minutes of regadenoson stress demonstrated best concordance with significant ischemia and may be a promising tool for detection of transient ischemic functional changes with Tc-99m HE-SPECT.

    Brodov Y, Fish M, Rubeaux M, Otaki Y, Gransar H, Lemley M, et al.
    J Nucl Cardiol. 2016 Dec;23(6):1251-1261.
    12/2016
    Impact of integrating heart rate response with perfusion imaging on the prognostic value of regadenoson SPECT myocardial perfusion imaging in patients with end-stage renal disease
    Heart rate response; end-stage renal disease; myocardial perfusion imaging; outcome; prognosis; regadenoson

    BACKGROUND: We investigated whether integrating heart rate response (HRR) to regadenoson with myocardial perfusion imaging (MPI) analysis can enhance risk prediction in end-stage renal disease (ESRD) patients.

    METHODS AND RESULTS: We prospectively followed 303 ESRD patients after regadenoson stress MPI for a mean of 35 months. Normal HRR to regadenoson was defined as ≥28% increase from baseline. Normal MPI was defined as a summed stress score ≤3 and left ventricular ejection fraction ≥50%. The study cohort was divided in four groups based on various combinations of normal/abnormal HRR and MPI. There was a step-wise increase in the risk of primary endpoint of all-cause death and the composite secondary endpoint of cardiac death or myocardial infarction; patients with Normal MPI/Normal HRR had the lowest event rates and those with Abnormal MPI/Abnormal HRR had the highest, whereas subjects with Abnormal MPI/Normal HRR and Normal MPI/Abnormal HRR had intermediate event rates. This pattern was maintained after adjusting for important clinical covariates.

    CONCLUSION: In ESRD patients, integrating HRR to vasodilator stress with MPI interpretation improves risk stratification. Normal HRR/Normal MPI identify truly low-risk group, whereas abnormal MPI or abnormal HRR portrays elevated risk.

    Gomez J, Fughhi I, Campagnoli T, Ali A, Doukky R.
    J Nucl Cardiol. [Epub ahead of print]
    01/2016
    Impact of a regimented aminophylline administration protocol on the burden of regadenoson-induced ischemia detected by SPECT myocardial perfusion imaging
    Regadenoson; SPECT; aminophylline; ischemia; myocardial perfusion imaging (MPI).

    BACKGROUNDIn patients undergoing regadenoson SPECT myocardial perfusion imaging (MPI), it is unknown how soon and at which dose intravenous aminophylline can be administered to reverse regadenoson-related adverse effects without blunting stress-induced myocardial ischemia.

    METHODS AND RESULTS: We analyzed the pooled database of the ASSUAGE and ASSUAGE-CKD trials (n = 548). These were double-blinded, placebo-controlled, randomized clinical trials in which 75 mg of aminophylline or placebo was administered intravenously 90 seconds following 99mTc-tetrofosmin injection. There were no statistically significant differences in summed difference score (SDS) burden (P = .87) and in the rates of myocardial ischemia (SDS ≥ 2) (P = .93) between the aminophylline (n = 274) and placebo (n = 274) groups. There was no interaction between aminophylline use and SDS as a determinant of the composite endpoint of cardiac death or MI (P = .32) or the composite endpoint of cardiac death, MI, or coronary revascularization (P = .92).

    CONCLUSIONIn patients undergoing regadenoson-stress SPECT-MPI, the intravenous administration of 75 mg of aminophylline as early as 90 seconds after radioisotope injection does not seem to attenuate the burden of myocardial ischemia.

    Fughhi I, Campagnoli T, Ali A, Doukky R.
    J Nucl Cardiol. 2016 May 27.
    01/2016
    Safety of regadenoson in patients with severe chronic obstructive pulmonary disease
    Adverse events; Severe chronic obstructive pulmonary disease; Myocardial perfusion imaging; Regadenoson; Safety;

    OBJECTIVE: To assess the safety of regadenoson, a selective agonist of A2A adenosine receptors, combined with low-level exercise in subjects with severe chronic obstructive pulmonary disease (COPD), referred for myocardial perfusion imaging (MPI).

    METHODS: We studied prospectively 12 male patients with severe COPD. Stress was 4min of low-level exercise with bolus injection of regadenoson (0.4mg) at 1.5min, followed by (99m)Tc-MPI agent injection. Demographics, medical history, lung medications, adverse events, oxygen saturation (SatO2), MPI findings for coronary artery disease (CAD), and changes in systolic blood pressure (SBP), and heart rate (HR) were registered.

    RESULTS: The observed adverse event profile of regadenoson was similar to that of patients with mild-moderate COPD. There was no clinical exacerbation of COPD. Adverse events were self-limiting: dyspnea (33.3%), fatigue (25.0%), chest pain, headache (16.7%, respectively), and gastrointestinal discomfort, dry mouth, flushing, feeling hot and dizziness (8.3%, respectively). 25.0% of patients did not report any symptoms. We observed significant increases in SBP and HR from baseline (142.6mmHg±22.3 vs 152.5mmHg±18.5, and 80 b.p.m.±18 vs 105 b.p.m.±22, respectively; p<0.05).

    CONCLUSIONS: Regadenoson combined with low-level exercise is safe and well tolerated in stable patients with severe COPD undergoing MPI.

    Salgado-Garcia C, Jimenez-Heffernan A, Ramos-Font C, Lopez-Martin J, Sanchez-de-Mora E, Aroui T, et al.
    Rev Esp Med Nucl Imagen Mol. 2016 Sep-Oct;35(5):283-6.
    01/2016
    Three-dimensional quantification of myocardial perfusion during regadenoson stress computed tomography
    Cardiovascular CT; Coronary artery disease; Multi-detector CT; Myocardial ischemia; Myocardium; Perfusion.

    BACKGROUNDThere is no accepted methodology for CT-based vasodilator stress myocardial perfusion imaging and analysis. We developed a technique for quantitative 3D analysis of CT images, which provides several indices of myocardial perfusion. We sought to determine the ability of these indices during vasodilator stress to identify segments supplied by coronary arteries with obstructive disease and to test the accuracy of the detection of perfusion abnormalities against SPECT.

    METHODSWe studied 93 patients referred for CT coronary angiography (CTCA) who underwent regadenoson stress. 3D analysis of stress CT images yielded segmental perfusion indices: mean X-ray attenuation, severity of defect and relative defect volume. Each index was averaged for myocardial segments, grouped by severity of stenosis: 0%, <50%, 50-70%, and >70%. Objective detection of perfusion abnormalities was optimized in 47 patients and then independently tested in the remaining 46 patients.

    RESULTS: CTCA depicted normal coronary arteries or non-obstructive disease in 62 patients and stenosis of >50% in 31. With increasing stenosis, segmental attenuation showed a 7% decrease, defect severity increased 11%, but relative defect volume was 7-fold higher in segments with obstructive disease (p<0.001). In the test group, detection of perfusion abnormalities associated with stenosis >50% showed sensitivity 0.78, specificity 0.54, accuracy 0.59. When compared to SPECT in a subset of 21 patients (14 with abnormal SPECT), stress CT perfusion analysis showed sensitivity 0.79, specificity 0.71, accuracy 0.76.

    CONCLUSIONS: 3D analysis of vasodilator stress CT images provides quantitative indices of myocardial perfusion, of which relative defect volume was most robust in identifying segments supplied by arteries with obstructive disease. This study may have implications on how CT stress perfusion imaging is performed and analyzed.

    Mor-Avi V, Kachenoura N, Maffessanti F, Bhave NM, Port S, Lodato JA, et al.
    Eur J Radiol. 2016 May;85(5):885-92.
    01/2016
    The reproducibility and prognostic value of serial measurements of heart rate response to regadenoson during myocardial perfusion imaging
    Coronary artery disease; Heart rate response; Myocardial perfusion imaging; Regadenoson; Vasodilator stress.

    PURPOSEThe heart rate response (HRR, percentage change from baseline) to regadenoson during myocardial perfusion imaging (MPI) can provide incremental prognostic value in patients with known or suspected coronary artery disease. Our purpose was to evaluate the variability and prognostic value of HRR on serial measurements.

    METHODS: We studied 648 consecutive patients (61 ± 11 years, 48 % with diabetes) who underwent two regadenoson MPI studies (16 ± 9 months between studies). HRR <30 % was defined as abnormal. All-cause mortality was determined by chart review and verified using the US Social Security Death Master File.

    RESULTSHRR was well correlated between the two studies (intraclass correlation coefficient 0.72, 95 % CI 0.67 - 0.76) with no systematic bias (mean difference 0.88 %, p = 0.2) or proportional bias (p = 0.5) by Bland-Altman analysis in all patients and in those with normal MPI on both studies. Of the 308 patients (48 %) with normal baseline HRR (HRR-1), 33 % had developed a blunted HRR on the second MPI study (HRR-2). Older age, male gender, end-stage renal disease, and abnormal baseline left ventricular ejection fraction were independent predictors of a new-onset abnormal HRR. During a mean follow-up of 2.4 ± 1.2 years, 55 patients (8.5 %) died. Patients with a blunted HRR-1 had increased mortality risk irrespective of their HRR-2 (p = 0.9, log-rank test). Among patients with normal HRR-1, a blunted HRR-2 was an independent predictor of all-cause mortality beyond clinical and traditional MPI data (hazard ratio 2.83, 95 % CI 1.14 - 7.03). Finally, patients with a normal HRR-1 and HRR-2 had the lowest event rate, while those with any abnormal HRR had an increased risk of death (hazard ratio 2.5, 95 % CI 1.2 - 5.4).

    CONCLUSION: There was good correlation in the HRR to regadenoson on serial measurements without systematic or proportional biases. Patients with consistently normal HRR had the best prognosis.

    Andrikopoulou E, AlJaroudi WA, Farag A, Lester D, Patel H, Iskandrian AE, et al.
    Eur J Nucl Med Mol Imaging. 2016 Jul;43(8):1493-502.
    01/2016
    Intravenous caffeine: An alternative to aminophylline to reverse adverse effects during regadenoson myocardial perfusion imaging

    Aminophylline has long been used in the reversal of vasodilators used for myocardial perfusion imaging. However, in 2010, manufacturers of aminophylline reported shortages making a search for an alternative a high priority. In this issue of the Journal, Doral et al, at the University of Rochester report their evaluation of the effectiveness of intravenous (IV) and oral caffeine as an alternative to IV aminophylline in the reversal of adverse effects of regadenoson. They randomized 241 patients to receive 100 mg of IV aminophylline, 60 mg of IV caffeine, or a caffeinated beverage, either diet soda or caffeinated coffee, if adverse symptoms occurred. They provided a 5-minute delay before offering a reversal agent to allow for adequate myocardial extraction of the radiotracer. Exercise was encouraged during administration of regadenoson and performed in 22% of patients. The primary endpoint was complete resolution (CR) of symptoms. If a patient did not achieve CR, they were classified into incomplete response (IR), predominant response (PRE), partial response (PR), or no response (NR). PRE was defined as ≥50% resolution of the number of symptoms; PR was defined as less than 50% resolution of the number of symptoms. A secondary end point was time from initiation of the reversal agent until CR.

    Jolly AF, Thomas GS.
    J Nucl Cardiol. 2016 Apr 12.
    01/2016
    Aminophylline and caffeine for reversal of adverse symptoms associated with regadenoson SPECT MPI
    A2A adenosine receptor agonists; Pharmacologic stress; caffeine; myocardial perfusion imaging: SPECT; vasodilator stress.

    BACKGROUND: Aminophylline shortages led us to compare intravenous (IV) aminophylline with IV and oral (PO) caffeine during routine pharmacologic stress testing with SPECT MPI.

    METHODSWe measured presence, duration, and reversal of adverse symptoms and cardiac events following regadenoson administration in consecutive patients randomized to IV aminophylline (100 mg administered over 30-60 seconds), IV caffeine citrate (60 mg infused over 3-5 minutes), or PO caffeine as coffee or diet cola.

    RESULTSOf 241 patients, 152 (63%) received regadenoson reversal intervention. Complete (CR), predominant (PRE), or partial (PR) reversal was observed in 99%. CR by IV aminophylline (87%), IV caffeine (87%), and PO caffeine (78%) were similar (P = NS). Time to CR (162 ± 12.6 seconds, mean ± SD) was similar in treatment arms. PO caffeine was inferior to IV aminophylline for CR + PRE.

    CONCLUSIONS: IV aminophylline and IV caffeine provide rapid, safe reversal of regadenoson-induced adverse effects during SPECTMPI. Oral caffeine appeared similarly effective for CR but not for the combined CR + PRE. Our results suggest PO caffeine may be an effective initial strategy for reversal of regadenoson, but IV aminophylline or IV caffeine should be available to optimize symptom reversal as needed

    Doran JA, Sajjad W, Schneider MD, Gupta R, Mackin ML, Schwartz RG.
    J Nucl Cardiol. 2016 Mar 29. [Epub ahead of print]
    01/2016
    An assessment of the safety, hemodynamic response, and diagnostic accuracy of commonly used vasodilator stressors in patients with severe aortic stenosis
    SPECT MPI; Severe aortic stenosis; adenosine; dipyridamole; regadenoson.

    BACKGROUND: Increasing numbers of patients are undergoing transcatheter aortic valve replacement, which often involves assessment of coronary artery disease ischemic burden. The safety and diagnostic accuracy of vasodilator stress agents in patients with severe aortic stenosis (AS) undergoing SPECT myocardial perfusion imaging (MPI) has not been established.

    METHODS: Patients with severe AS (valve area <1 cm2) on echocardiography who underwent vasodilator stress SPECT MPI at two centers were identified. Patients with aortic valve intervention prior to MPI or who underwent concurrent exercise during stress testing were excluded. AS patients were matched to controls without AS based on age, gender, BMI, ejection fraction, and stress agent. Symptoms, serious adverse events, hemodynamic response, and correlation to invasive angiography were assessed.

    RESULTS: A total of 95 cases were identified with 45% undergoing regadenoson, 31% dipyridamole, and 24% adenosine stress. A significant change in systolic blood pressure (BP), cases vs controls, was observed with adenosine [-17.9 ± 20.1 vs -2.6 ± 24.9 P = .03)], with a trend toward significance with regadenoson [-16.8 ± 20.3 vs -9.4 ± 17.9 (P = .08)] and dipyridamole [-17.8 ± 20.6 vs -9.0 ± 12.1 (P = .05)]. The change in heart rate was significantly different only for adenosine [5.3 ± 16.8 vs 14.2 ± 10.8 (P = .04)]. Overall, 45% of cases vs 24% of controls (P = .004) had a >20 mmHg decrease in systolic BP. Age, BMI, and resting systolic BP were related to a >20 mmHg decrease in systolic BP on univariate analysis, although only higher resting systolic BP was a predictor on multivariate analysis. In 33 patients who underwent angiography, the sensitivity, specificity, and diagnostic accuracy of vasodilator stress MPI was 77%, 69%, and 73%, respectively. No serious adverse events occurred in the severe AS patients.

    CONCLUSION: Severe AS patients are more likely to have a hemodynamically significant decrease in systolic BP with vasodilator stress. There were no serious adverse events in this severe AS cohort with good diagnostic performance of MPI compared to angiography.

    Hussain N, Chaudhry W, Ahlberg AW, Amara RS, Elfar A, Parker MW, et al.
    J Nucl Cardiol. 2016 Mar 15.
    01/2016
    Safety and tolerability of regadenoson for myocardial perfusion imaging - first Danish experience
    Adverse event; myocardial perfusion imaging; regadenoson; safety; stress testing.

    OBJECTIVES: Evaluating safety and tolerability of the selective A2A receptor agonist, regadenoson, in patients referred for single photon emission computed tomography myocardial perfusion imaging (MPI).

    DESIGN: Observational study of patients referred for MPI stress testing using a 400 μg regadenoson (Rapiscan(®)) bolus. Hemodynamic variables and severity of adverse events (AE) were recorded before, during, and after administration.

    RESULTS: A total of 232 patients were included. One or more AE were reported in 90% of patients; the AEs were graded mostly mild to moderate in severity, resolved spontaneously, and were mainly dyspnea, headache, and chest pain. No advanced heart block or bronchospasm were seen. Transient ST-segment changes developed in 10 patients. The maximum increase in heart rate was 19 ± 11 beats/minute. The mean systolic blood pressure decreased from 144 to 139 mmHg (p < 0.0001). Medical intervention was required in three patients: one case with severe hypotension and two cases with chest pain that was relieved with sublingual nitroglycerin. One patient died the day after stress MPI for reasons considered unrelated to regadenoson.

    CONCLUSION: Regadenoson for MPI is easy to use with a high frequency of AEs, which are generally mild in severity, transient, and resolve spontaneously.

    Pape M, Zacho HD, Aarøe J, Eggert Jensen S, Petersen LJ.
    Scand Cardiovasc J. 2016 Jun;50(3):180-6.
    01/2016
    Safety of vasodilator stress myocardial perfusion imaging in patients with elevated cardiac biomarkers
    Regadenoson; Troponin; exercise stress; myocardial perfusion imaging; vasodilator stress.

    BACKGROUND: While adenosine and dipyridamole as myocardial perfusion imaging (MPI) stress agents have literature supporting their safety in the setting of myocardial infarction (MI), regadenoson does not. Studying a high risk cohort of patients with elevated cardiacbiomarkers may shed light on potential safety issues of these agents which might also affect lower risk cohorts.

    METHODSAll patients who had undergone a clinically indicated stress MPI study at two academic centers from 1/1/2010 through 12/31/2012 with elevated troponin ≤7 days prior to testing were included. The primary endpoint was a composite of death, non-fatal MI, congestive heart failure (CHF), stroke, ventricular arrhythmias, atrial fibrillation/flutter, or atrioventricular block requiring intervention within 24 h of testing.

    RESULTSOf the 703 stress MPI studies that met inclusion criteria, 360 (51.2%), 199 (28.3%), 74 (10.5%), 9 (1.3%), and 61 (8.7%) underwent regadenoson, dipyridamole, adenosine, dobutamine, and exercise stress, respectively. The primary endpoint occurred in 11 (1.6%) patients with an incidence of 1.4% (n = 5), 1.0% (n = 2), 1.4% (n = 1), 11.1% (n = 1), and 3.3% (n = 2) following regadenoson, dipyridamole, adenosine, dobutamine, and exercise stress, respectively (P = 0.137). The adverse events included non-fatal MI in 7 (1.0%) patients, death in 1 (0.1%) patient, CHF in 1 (0.1%) patient, ventricular arrhythmia in 1 (0.1%) patient, and atrial arrhythmia in 1 (0.1%) patient.

    CONCLUSIONIn the setting of elevated troponin, serious complications associated with either exercise or vasodilator stress testing appear to be relatively rare with no increased risk attributable to a particular vasodilator agent.

    Rai M, Ahlberg AW, Marwell J, Chaudhary W, Savino JA 3rd, Alter EL, et al.
    J Nucl Cardiol. 2016 Feb 22. [Epub ahead of print]
    01/2016
    Review of Cardiovascular Imaging in the Journal of Nuclear Cardiology in 2015-Part 2 of 2: Myocardial perfusion imaging
    Myocardial perfusion imaging; SPECT; appropriateness; dyssynchrony; phase analysis; regadenoson; safety.

    In 2015, the Journal of Nuclear Cardiology (®) published many high-quality articles. In this series, we will summarize key articles that have appeared in the Journal last year to provide for the interested reader a quick review of the advancements that have recently occurred in the field. In the first article of this 2-part series, we concentrated on publications dealing with plaque imaging, cardiac positron emission tomography, computed tomography, and magnetic resonance. This review will focus on myocardial perfusion imaging summarizing advances in the field including in diagnosis, prognosis, and appropriate use.

    Hage FG, AlJaroudi WA.
    J Nucl Cardiol. 2016 Jun;23(3):493-8.
    01/2016
    Regadenoson stress for myocardial perfusion imaging
    coronary artery disease; myocardial perfusion imaging; regadenoson.

    Noninvasive functional imaging plays a major role in the diagnosis of hemodynamically significant coronary artery disease (CAD) by means of the detection of abnormal myocardial perfusion. For this, cardiac stressors are essential as they induce hypoperfusion in the presence of flow-limiting coronary stenosis. Several pharmacological stressors are currently available and it is important that clinicians who are involved in the care and management of patients with CAD become familiar with their indications, contraindications and protocols. Among the primary coronary vasodilator agents, regadenoson is increasingly used as the default stressor or as an alternative to other modalities of stress. This article provides an updated review of regadenoson stress for the assessment of patients with suspected or known CAD and describes its pharmacological properties, stress protocol, efficacy and safety profile.

    Reyes E.
    Future Cardiol. 2016 Jan;12(1):59-67.
    01/2016
    The effect of regadenoson-induced transient disruption of the blood-brain barrier on temozolomide delivery to normal rat brain
    Blood–brain barrier; Brain metastases; Brain tumor; Pharmacology; Regadenoson; TemozolomideBlood–brain barrier; Brain metastases

    The blood-brain barrier (BBB) significantly reduces the delivery of many systemically administered agents to the central nervous system. Although temozolomide is the only chemotherapy to improve survival in patients with glioblastoma, its concentration in brain is only 20 % of that in blood. Regadenoson, an FDA approved adenosine receptor agonist used for cardiac stress testing, transiently disrupts rodent BBB allowing high molecular weight dextran (70 kD) to enter the brain. This study was conducted to determine if regadenoson could facilitate entry of temozolomide into normal rodent brain. Temozolomide (50 mg/kg) was administered by oral gavage to non-tumor bearing F344 rats. Two-thirds of the animals received a single dose of intravenous regadenoson 60-90 min later. All animals were sacrificed 120 or 360 min after temozolomide administration. Brain and plasma temozolomide concentrations were determined using HPLC/MS/MS. Braintemozolomide concentrations were significantly higher at 120 min when it was given with regadenoson versus alone (8.1 ± 2.7 and 5.1 ± 3.5 µg/g, P < 0.05). A similar trend was noted in brain:plasma ratios (0.45 ± 0.08 and 0.29 ± 0.09, P < 0.05). Brain concentrations and brain:plasma ratios were not significantly different 360 min after temozolomide administration. No differences were seen in plasma temozolomide concentrations with or without regadenoson. These results suggest co-administration of regadenoson with temozolomide results in 60% higher temozolomide levels in normal brain without affecting plasma concentrations. This novel approach to increasing intracranial concentrations of systemically administered agents has potential to improve the efficacy of chemotherapy in neuro-oncologic disorders.

    Jackson S, Anders NM, Mangraviti A, Wanjiku TM, Sankey EW, Liu A, et al.
    J Neurooncol. 2016 Feb;126(3):433-9.
    01/2016
    Prognostic value of transient ischemic dilation with regadenoson myocardial perfusion imaging
    Myocardial perfusion imaging; outcomes; regadenoson; transient ischemic dilation.

    BACKGROUND: Transient ischemic dilation (TID) of the left ventricle seen on myocardial perfusion imaging (MPI) is sometimes used as a marker of severe coronary artery disease. The prognostic value of TID obtained using regadenoson, a selective adenosine A2A receptor agonist, as a stress agent for MPI has not been studied.

    METHODSTID ratio was measured using an automated software program on consecutive patients with normal and abnormal perfusion pattern on regadenoson MPI at a single institution. An abnormal TID was defined as greater than 1.33. The primary outcome was a composite of cardiac death, non-fatal myocardial infarction (MI), and late coronary revascularization (CR, >90 days after MPI).

    RESULTS: The study population consisted of 887 patients (62 ± 12 years, 66% male, 48% diabetes, 46% prior CR, 75% with abnormal perfusion pattern, left ventricular ejection fraction-LVEF 55 ± 6%). An abnormal TID was present in 51 (6%) patients. Baseline characteristics were not different based on the presence or absence of TID. Early CR (≤90 days) was performed in 11 (22%) patients with vs 92 (11%) patients without TID (P = .04). During a mean follow-up of 29 ± 19 months, the primary outcome occurred in 271 (31%) patients (22% cardiac death, 6% MI, 9% late CR). TID was associated with increased risk of the primary outcome (log-rank P = .017), an association largely driven by late CR. In a Cox proportional model adjusted for multiple variables including perfusion defect size (PDS) and LVEF, the hazard ratio for TID was 1.92 (95% CI 1.20-3.08, P = .007). In the subset of patients with normal perfusion pattern, there was no association between TID and outcomes.

    CONCLUSIONS: TID on regadenoson MPI carries important prognostic information that is independent from PDS and LVEF, but this association is restricted to patients with abnormal perfusion on imaging.

    Lester D, El-Hajj S, Farag AA, Bhambhvani P, Tauxe L, Heo J, et al.
    J Nucl Cardiol. 2016 Oct;23(5):1147-55.
    10/2016
    Prognostic impact of TID in regadenoson MPI: Some patients and certain events

    Single-photon emission-computed tomographic (SPECT) myocardial perfusion imaging (MPI) has incremental diagnostic and prognostic value over exercise stress electrocardiography, and the assessment of transient ischemic dilation (TID) is a key contributor to its ability to detect higher risk patients. The diagnostic and prognostic role of TID has been evaluated extensively in those undergoing exercise MPI. However, approximately 50% of the ≈10 million MPI studies performed annually in the US undergo pharmacologic MPI, the majority receiving regadenoson for vasodilator stress due to its improved tolerability by patients, safety profile, and ease of administration. Given the high prevalence of this testing, the significance of TID in this population is of high importance. The diagnostic role of TID in regadenoson MPI has been assessed previously, but the prognostic impact has not determined.

    Löffler AI, Bourque JM.
    J Nucl Cardiol. 2016 Oct;23(5):1156-9.
    10/2016
    ST Segment Elevation ECG Changes During Pharmacologic Stress With Regadenoson

    Regadenoson is a pharmacologic stress agent that has been widely adopted as an alternative over other pharmacologic vasodilator agents due to its ease of use, patient tolerance, and safety profile. We report the case of dynamic ST-segment elevation electrocardiogram changes after regadenoson injection during an inpatient single-photon emission computed tomography myocardial perfusion stress test, with subsequent coronary angiography revealing the presence of hemodynamically significant coronary artery disease. Our findings confirm that transient regadenoson-induced ST-segment elevations are a marker for hemodynamically significant disease even in the setting of low-risk SPECT perfusion images.

    Qamruddin S, Huang HW, Mehra A, Bonyadlou S, Yoon AJ.
    Clin Nucl Med. 2016 Jan;41(1):62-4.
    01/2016
    Heart rate response to regadenoson: Making the case for its value in clinical practice

    Single-photon emission computed tomography myocardial perfusion imaging (MPI) using regadenoson as a stress agent carries a wealth of prognostic data as documented by a series of recent studies. It is, therefore, natural to pose the following questions, when reading about a novel prognostic indicator derived from regadenoson MPI: Is there really a need for another risk predictor in patients undergoing regadenoson MPI? Will this novel predictor add value to the information that is already available to me? In which patient populations is it useful? How will I use this in my daily clinical practice?

    Andrikopoulou E, Hage FG.
    J Nucl Cardiol. 2016 Jun;23(3):575-80.
    01/2016
    Prognostic value of heart rate response during regadenoson stress myocardial perfusion imaging in patients with end stage renal disease
    Heart rate response; end-stage renal disease; myocardial perfusion imaging; outcome; prognosis; regadenoson.

    BACKGROUND: Blunted heart rate response (HRR) to vasodilator stress agents is associated with worse outcomes. There are limited data assessing the effect of impaired HRR to regadenoson among patients with end-stage renal disease (ESRD) undergoing stressmyocardial perfusion imaging (MPI).

    METHODSWe prospectively followed patients with ESRD enrolled in the ASSUAGE and ASSUAGE-CKD trials. HRR was defined as 100*(peak stress heart rate-resting heart rate)/resting heart rate. Study cohort was dichotomized to blunted and normal HRR groups according to an established median HRR value <28% or ≥28%, which were propensity-score matched based on 22 clinical and imaging covariates. The Primary endpoint was all-cause death. The secondary cardiac-specific endpoints included: (1) the composite endpoint of cardiac death or myocardial infarction; (2) the composite endpoint of cardiac death, myocardial infarction, or late (>90 days) coronary revascularization.

    RESULTS: There were 303 patients followed for 35 ± 10 months. In the entire cohort, there was a stepwise increase in the rates of death and all secondary endpoints with worsening HRR (P values ≤.001). Blunted HRR (<28%) was associated with increased risk of death (unadjusted hazard ratio 4.10 [1.98-8.46], P < .001) and all secondary endpoints (P ≤ .001). After multivariate adjustment, HRR remained an independent predictor of mortality and secondary endpoints whether used as continuous or dichotomous variable, and added incremental prognostic value for all-cause death (P = .046). Blunted HRR was associated with increased event rate among patients with normal myocardial perfusion (P = .001) and abnormal perfusion (P = .053). In the propensity-matched cohort of 132 patients (66 in each group), blunted HRR was associated with significant increase in all-cause death (21% vs. 5%, HR 5.09 [1.46-17.7], P=.011), and similarly for the secondary endpoints.

    CONCLUSION: Blunted HRR (<28%) to regadenoson is a strong and independent predictor of death and cardiovascular events in patients with ESRD and adds incremental prognostic value.

    AlJaroudi W, Campagnoli T, Fughhi I, Wassouf M, Ali A, Doukky R.
    J Nucl Cardiol. 2016 Jun;23(3):560-9.
    01/2016
    Effect of changes in perfusion defect size during serial regadenoson myocardial perfusion imaging on cardiovascular outcomes in high-risk patients
    Myocardial perfusion imaging; outcomes; regadenoson; serial.

    BACKGROUND: The prognostic value of single-photon emission computed tomography myocardial perfusion imaging (MPI) is well established. There is a paucity of data on the prognostic value of changes in perfusion defect size (PDS) on serial MPIs.

    METHODSFrom the MPI database at the University of Alabama at Birmingham, consecutive patients who underwent two regadenoson stress MPIs between July 2008 and March 2013 were identified. The MPIs were analyzed side-by-side using an automated software program for presence and change in PDS. Improvement in PDS was defined as a reduction ≥5% of left ventricle. A drop in left ventricular ejection fraction (LVEF) was defined as a decrease ≥5%. The primary outcome was a composite of death, myocardial infarction (MI), and coronary revascularization (CR).

    RESULTSThere were 698 patients (61 ± 11 years, 53% male, 48% diabetes, 25% prior MI, 49% prior CR) who underwent two regadenoson MPIs within 16 ± 9 months for clinical indications. The primary outcome occurred in 167 (24%) patients (8% death, 9% MI, 15% CR) during 24 ± 16 months of follow-up after the second MPI. The MPIs were normal in both studies in 399 (57%, Group 1), showed improvement in 94 (14%, Group 2, PDS 15% ± 16% vs 28% ± 18%, P < .001) and no change or worsening in 205 patients (29%, Group 3, 28% ± 17% vs 20% ± 17%, P < .001). The best outcomes were seen in Group 1 and the worst in Group 3 (log-rank P < .001). Similar trends were seen for the components of the primary outcome (P = .04 for death, P < .001 for MI, P < .001 for CR). In a Cox-regression model that adjusted for baseline factors including PDS and LVEF on initial MPI, the hazard ratios for primary outcome were 2.0 (P = .02) and 3.9 (P < .001) for Groups 2 and 3 compared to Group 1, respectively. In addition, an LVEF drop ≥5% was independently associated with the primary outcome (HR 1.5, P = .01).

    CONCLUSIONChanges in PDS and LVEF on serial MPIs provide incremental prognostic information to initial and follow-up MPI findings. Lack of improvement or an increase in PDS and a drop in LVEF identify high-risk patients.

    El-Hajj S, AlJaroudi WA, Farag A, Bleich S, Manaoragada P, Iskandrian AE, et al.
    J Nucl Cardiol. 2016 Feb;23(1):101-12.
    01/2016

    SEMNIM

    Sociedad Española de Medicina Nuclear e Imagen Molecular. Grupo de trabajo Cardiología nuclear.

    SEC

    Sociedad Española de Cardiología. Sección de imagen cardiaca.

    EANM

    European Association of Nuclear Medicine.

    ASNC

    American Society of Nuclear Cardiology.

    Protocolo de inyección de Rapiscan®

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    European Association of Nuclear Medicine 

    Guía de procedimiento para imagen de perfusión miocárdica con radionúclidos en SPECT y SPECT/TC, revisión de 2015.

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    2017

    30th Annual Congress EANM, 21-25 Octubre 2017

    EANM. European Association of Nuclear Medicine.

    Viena, Austria
     

    XXXVI Congreso SEMNIM, 24-26 Mayo 2017

    SEMNIM. Sociedad Española de Medicina Nuclear e Imagen Molecular.

    Palma de Mallorca
     

    XXXV Congreso de la Sección de Imagen Cardiaca, 30 Marzo-1 Abril 2017

    SEC. Sociedad Española de Cardiología.

    Barcelona
     

    2016

    29th Annual Congress EANM, 15-19 Octubre 2016

    EANM. European Association of Nuclear Medicine.

    Barcelona
     

    2015

    28th EANM, 10-14 Octubre  2015

    EANM. European Association of Nuclear Medicine.

    Hamburgo, Alemania
     

    XXXV Congreso SEMNIM, 17-19 Junio 2015

    SEMNIMSociedad Española de Medicina Nuclear e Imagen Molecular.

    Burgos

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    Última modificación: 13/02/2017