Skip to main content

Advertisement

SpringerLink
Log in

Safety of regadenoson positron emission tomography stress testing in orthotopic heart transplant patients

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Objectives

We sought to determine the safety of regadenoson (REG) stress testing in patients who have undergone orthotopic heart transplantation (OHT).

Background

Routine screening for cardiac allograft vasculopathy (CAV) is necessary after OHT. Adenosine stress is contraindicated after heart transplantation due to supersensitivity in denervated hearts. Safety of regadenoson stress following OHT has not been well studied.

Methods

We retrospectively reviewed data from OHT patients (N = 123) who were referred to REG stress testing. Medical records were reviewed to determine hemodynamic and ECG response to regadenoson and to identify adverse reactions.

Results

No serious adverse events occurred. No life-threatening arrhythmias or hemodynamic changes occurred. Common side-effects related to regadenoson were observed, dyspnea being the most frequent (66.7%). On average the heart rate rose from 82.8 ± 12 to 95.7 ± 13.4 bpm (P < 0.001), systolic blood pressure decreased from 138.7 ± 20.9 to 115.9 ± 23.9 mmHg (P < 0.001) and mean arterial pressure decreased from 103.5 ± 14.1 to 84.72 ± 15.90 mmHg (P < 0.001) during stress protocol. There was no sustained ventricular tachycardia, ventricular fibrillation, or second-or third-degree atrioventricular block.

Conclusion

Regadenoson stress testing appears to be well tolerated and safe in OHT patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CAV:

Cardiac allograft vasculopathy

OHT:

Orthotropic heart transplant

IVUS:

Coronary intravascular ultrasound

REG:

Regadenoson

PET:

Positron emission tomography and myocardial perfusion imaging using regadenoson

VT:

Ventricular tachycardia

VF:

Ventricular fibrillation

References

  1. Lund LH, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dipchand AI, Dobbels F, Goldfarb SB, Levvey BJ, Meiser B, Yusen RD, Stehlik J, International Society of H and Lung T. The registry of the International Society for Heart and Lung Transplantation: thirty-first official adult heart transplant report - 2014; focus theme: retransplantation. J Heart Lung Transplant 2014;33:996-1008.

    Article  Google Scholar 

  2. Wilhelm MJ. Long-term outcome following heart transplantation: current perspective. J Thorac Dis 2015;7:549-51.

    PubMed  PubMed Central  Google Scholar 

  3. Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, Fedson S, Fisher P, Gonzales-Stawinski G, Martinelli L, McGiffin D, Smith J, Taylor D, Meiser B, Webber S, Baran D, Carboni M, Dengler T, Feldman D, Frigerio M, Kfoury A, Kim D, Kobashigawa J, Shullo M, Stehlik J, Teuteberg J, Uber P, Zuckermann A, Hunt S, Burch M, Bhat G, Canter C, Chinnock R, Crespo-Leiro M, Delgado R, Dobbels F, Grady K, Kao W, Lamour J, Parry G, Patel J, Pini D, Towbin J, Wolfel G, Delgado D, Eisen H, Goldberg L, Hosenpud J, Johnson M, Keogh A, Lewis C, O’Connell J, Rogers J, Ross H, Russell S, Vanhaecke J, International Society of H and Lung Transplantation G. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant 2010;29:914-56.

    Article  Google Scholar 

  4. Bangalore S, Bhatt DL. Coronary intravascular ultrasound. Circulation 2013;127:e868-74.

    Article  Google Scholar 

  5. St Goar FG, Pinto FJ, Alderman EL, Valantine HA, Schroeder JS, Gao SZ, Stinson EB, Popp RL. Intracoronary ultrasound in cardiac transplant recipients. In vivo evidence of “angiographically silent” intimal thickening. Circulation 1992;85:979-87.

    Article  CAS  Google Scholar 

  6. Al-Mallah MH, Arida M, Garcia-Sayan E, Assal C, Zegarra GT, Czerska B, Ananthasubramaniam K. Safety of adenosine pharmacologic stress myocardial perfusion imaging in orthotopic cardiac transplant recipients: a single center experience of 102 transplant patients. Int J Cardiovasc Imaging 2011;27:1105-11.

    Article  Google Scholar 

  7. Ellenbogen KA, Thames MD, DiMarco JP, Sheehan H, Lerman BB. Electrophysiological effects of adenosine in the transplanted human heart. Evidence of supersensitivity. Circulation 1990;81:821-8.

    Article  CAS  Google Scholar 

  8. Lieu HD, Shryock JC, von Mering GO, Gordi T, Blackburn B, Olmsted AW, Belardinelli L, Kerensky RA. Regadenoson, a selective A2A adenosine receptor agonist, causes dose-dependent increases in coronary blood flow velocity in humans. J Nucl Cardiol 2007;14:514-20.

    Article  Google Scholar 

  9. Cavalcante JL, Barboza J, Ananthasubramaniam K. Regadenoson is a safe and well-tolerated pharmacological stress agent for myocardial perfusion imaging in post-heart transplant patients. J Nucl Cardiol 2011;18:628-33.

    Article  Google Scholar 

  10. Cerqueira MD, Nguyen P, Staehr P, Underwood SR, Iskandrian AE, Investigators A-MT. 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 2008;1:307-16.

    Article  Google Scholar 

  11. Iskandrian AE, Bateman TM, Belardinelli L, Blackburn B, Cerqueira MD, Hendel RC, Lieu H, Mahmarian JJ, Olmsted A, Underwood SR, Vitola J, Wang W, Investigators AM. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol 2007;14:645-58.

    Article  Google Scholar 

  12. Gordi T, Frohna P, Sun HL, Wolff A, Belardinelli L, Lieu H. A population pharmacokinetic/pharmacodynamic analysis of regadenoson, an adenosine A2A-receptor agonist, in healthy male volunteers. Clin Pharmacokinet 2006;45:1201-12.

    Article  CAS  Google Scholar 

  13. Mc Ardle BA, Davies RA, Chen L, Small GR, Ruddy TD, Dwivedi G, Yam Y, Haddad H, Mielniczuk LM, Stadnick E, Hessian R, Guo A, Beanlands RS, deKemp RA, Chow BJ. Prognostic value of rubidium-82 positron emission tomography in patients after heart transplant. Circ Cardiovasc Imaging 2014;7:930-7.

    Article  Google Scholar 

  14. Wu YW, Chen YH, Wang SS, Jui HY, Yen RF, Tzen KY, Chen MF, Lee CM. PET assessment of myocardial perfusion reserve inversely correlates with intravascular ultrasound findings in angiographically normal cardiac transplant recipients. J Nucl Med 2010;51:906-12.

    Article  Google Scholar 

  15. Murthy VL, Naya M, Foster CR, Hainer J, Gaber M, Di Carli G, Blankstein R, Dorbala S, Sitek A, Pencina MJ, Di Carli MF. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation 2011;124:2215-24.

    Article  Google Scholar 

Download references

Acknowledgements

Dr. Murthy is supported by 1R01HL136685 from the National, Heart, Lung, and Blood Institute. Dr. Murthy has received consulting/speaking fees from Bracco Diagnostics and Ionetix. Dr. Murthy owns stock in General Electric.

Disclosures

Keith Aaronson has received consultant or speaking fees from Medtronic, NuPulseCV and has stock options with ProCyrion and NuPulseCV. He has received grants or grants pending from Amgen, Medtronic and Thoratec. Venkatesh L. Murthy has received consulting/speaking fees from Bracco Diagnostics and Ionetix. He owns stock in General Electric. John J. Lazarus, Ashraf Saleh, Michael Ghannam, Monica Colvin, Frank Pagani, Todd Koelling, James R. Corbett, Richard L. Weinberg, and Matthew C. Konerman have no reported conflicts of interest.

Author information

Author notes

  1. Venkatesh L. Murthy and Matthew C. Konerman served as senior authors for this manuscript

Authors and Affiliations

  1. University of Michigan Frankel Cardiovascular Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5853, USA

    John J. Lazarus MD, PhD, Ashraf Saleh MD, Michael Ghannam MD, Keith Aaronson MD, Monica Colvin MD, Frank Pagani MD, PhD, Todd Koelling MD, James R. Corbett MD, Richard L. Weinberg MD, PhD, Venkatesh L. Murthy MD, PhD & Matthew C. Konerman MD

Authors
  1. John J. Lazarus MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashraf Saleh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Ghannam MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keith Aaronson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Monica Colvin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frank Pagani MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Todd Koelling MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. James R. Corbett MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Richard L. Weinberg MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Venkatesh L. Murthy MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Matthew C. Konerman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John J. Lazarus MD, PhD.

Additional information

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 148 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lazarus, J.J., Saleh, A., Ghannam, M. et al. Safety of regadenoson positron emission tomography stress testing in orthotopic heart transplant patients. J. Nucl. Cardiol. 27, 943–948 (2020). https://doi.org/10.1007/s12350-018-01466-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-018-01466-1

Keywords

Search

Navigation