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Journal of Nuclear Cardiology

, Volume 22, Issue 2, pp 248–261 | Cite as

Regadenoson provides perfusion results comparable to adenosine in heterogeneous patient populations: A quantitative analysis from the ADVANCE MPI trials

  • John J. Mahmarian
  • Leif E. Peterson
  • Jiaqiong Xu
  • Manuel D. Cerqueira
  • Ami E. Iskandrian
  • Timothy M. Bateman
  • Gregory S. Thomas
  • Faisal Nabi
Original Article

Abstract

Background

Total and reversible left ventricular (LV) perfusion defect size (PDS) predict patient outcome. Limited data exist as to whether regadenoson induces similar perfusion abnormalities as observed with adenosine. We sought to determine whether regadenoson induces a similar LV PDS as seen with adenosine across varying patient populations.

Methods and Results

ADVANCE MPI were prospective, double-blind randomized trials comparing regadenoson to standard adenosine myocardial perfusion tomography (SPECT). Following an initial adenosine SPECT, patients were randomized to either regadenoson (N = 1284) or a second adenosine study (N = 660). SPECT quantification was performed blinded to randomization and image sequence. Propensity analysis was used to define comparability of regadenoson and adenosine perfusion results. Baseline clinical and SPECT results were similar in the two randomized groups. There was a close correlation between adenosine and regadenoson-induced total (r 2 = 0.98, P < .001) and reversible (r 2 = 0.92, P < .001) PDS. Serial differences in total (0.00 ± 3.51 vs −0.11 ± 3.46, P = .51) and reversible (0.15 ± 3.79 vs 0.07 ± 3.33, P = .65) PDS were also comparable in patients randomized to regadenoson vs adenosine, respectively, and irrespective of age, gender, diabetic status, body mass index, or prior cardiovascular history. By propensity analysis, regadenoson-induced total PDS was significantly larger than observed with adenosine.

Conclusion

This is the first study to show that regadenoson induces similar, if not larger, perfusion defects than those observed with adenosine across different patient populations and demonstrates the value of quantitative analysis for defining serial changes in SPECT perfusion results. Regadenoson should provide comparable diagnostic and prognostic SPECT information to that obtained with adenosine.

Keywords

A2A adenosine receptor agonists myocardial perfusion imaging: SPECT vasodilator stress 

Notes

Disclosure

Drs Mahmarian, Cerqueira, and Thomas are consultants and on the Speakers Bureau for Astellas Pharma, Inc. Dr Bateman has served on Astellas Advisory Boards and has received grant research support from Astellas. The other authors have no conflict of interest.

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Copyright information

© American Society of Nuclear Cardiology 2014

Authors and Affiliations

  • John J. Mahmarian
    • 1
  • Leif E. Peterson
    • 2
  • Jiaqiong Xu
    • 2
  • Manuel D. Cerqueira
    • 3
  • Ami E. Iskandrian
    • 4
  • Timothy M. Bateman
    • 5
  • Gregory S. Thomas
    • 6
  • Faisal Nabi
    • 1
  1. 1.Houston Methodist DeBakey Heart & Vascular CenterHouston MethodistHoustonUSA
  2. 2.Houston Methodist Research InstituteHouston MethodistHoustonUSA
  3. 3.Cleveland ClinicClevelandUSA
  4. 4.University of Alabama at BirminghamBirminghamUSA
  5. 5.Mid America Heart Institute of Saint Luke’s HospitalKansas CityUSA
  6. 6.Long Beach Memorial Medical Center and University of California, IrvineOrangeUSA

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