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Incidence of atrioventricular block with vasodilator stress SPECT: A meta-analysis

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Adenosine or regadenoson are often used with pharmacologic stress testing. Adenosine may trigger atrioventricular block (AVB). Despite its higher selectivity, regadenoson has also been associated with AVB. We studied the incidence of de novo AVB with these agents.

Methods

A comprehensive search of SCOPUS was performed from inception to March 2016. Studies of at least 10 patients, using adenosine and/or regadenoson with SPECT-MPI, reporting rates of AVB were selected for further review.

Results

Thirty four studies were pooled including 22,957 patients. Adenosine was used in 21 studies and regadenoson in 15. Both were administered in two studies. The estimated incidence of overall and high-grade AVB was 3.81% (95% CI 1.99%-6.19%) and 1.93% (95% CI 0.77%-3.59%), respectively. The incidence of AVB (8.58%; 95% CI 5.55%-12.21% vs 0.30%; 95% CI 0.04%-0.82%, respectively, P < .001) and high-grade AVB (5.21%; 95% CI 2.81%-8.30% vs 0.05%; 95% CI < .001%-0.19% respectively, P < .001) were higher with adenosine compared to regadenoson.

Conclusion

AVB is seen in about 4% of patients undergoing vasodilator stress test. Both overall and high-grade AVB are more frequent with adenosine compared to regadenoson.

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Abbreviations

SPECT:

Single photon emission computed tomography myocardial perfusion imaging

MPI:

Myocardial perfusion imaging/images

AVB:

Atrioventricular block

SA:

Sinoatrial

CAD:

Coronary artery disease

HTN:

Hypertension

HLD:

Hyperlipidemia

CKD:

Chronic kidney disease

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Disclosures

Dr. Hage reports grant support from Astellas Pharma. No other disclosures from the rest of the authors.

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Authors and Affiliations

  1. University of Alabama at Birmingham, Birmingham, AL, USA

    Efstathia Andrikopoulou MD, Charity J. Morgan PhD, Lizbeth Brice MD, Navkaranbir S. Bajaj MD, MPH, Harish Doppalapudi MD, Ami E. Iskandrian MD, MASNC & Fadi G. Hage MD, MASNC

  2. Brigham and Women’s Hospital, Boston, MA, USA

    Efstathia Andrikopoulou MD & Navkaranbir S. Bajaj MD, MPH

  3. Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

    Harish Doppalapudi MD & Fadi G. Hage MD, MASNC

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  1. Efstathia Andrikopoulou MD
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  2. Charity J. Morgan PhD
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Correspondence to Efstathia Andrikopoulou MD.

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All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Nagara Tamaki, MD.

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Andrikopoulou, E., Morgan, C.J., Brice, L. et al. Incidence of atrioventricular block with vasodilator stress SPECT: A meta-analysis. J. Nucl. Cardiol. 26, 616–628 (2019). https://doi.org/10.1007/s12350-017-1081-y

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