Adenosine vs. regadenoson for stress induction in dynamic CT perfusion scan of the myocardium: A single‑center retrospective comparison

Gibarti,Claudia; Murín,Pavol; Huňavý,Mikuláš; Koribský,Roman; Urban,Lukáš; Studenčan,Martin; Gál,Peter

doi:10.3892/etm.2023.11891

Adenosine vs. regadenoson for stress induction in dynamic CT perfusion scan of the myocardium: A single‑center retrospective comparison

Authors:
- Claudia Gibarti
- Pavol Murín
- Mikuláš Huňavý
- Roman Koribský
- Lukáš Urban
- Martin Studenčan
- Peter Gál
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Affiliations: Department of Radiology, East‑Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia, Department of First Department of Cardiology, East‑Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia, Department of Biomedical Research, East‑Slovak Institute of Cardiovascular Diseases, Inc., 040 11 Košice, Slovakia
Published online on: March 16, 2023 https://doi.org/10.3892/etm.2023.11891
Article Number: 192
Copyright: © Gibarti et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Cardiac computed tomography (CT) angiography offers several approaches to determine the hemodynamic severity of coronary artery obstruction. Dynamic myocardial perfusion is based on serial CT imaging of contrast flow into the myocardium and calculation of absolute myocardial perfusion rates. East‑Slovak Institute of Cardiovascular Diseases has been the first center in Slovakia intensively using this modern technique to increase the quality level of non‑invasive diagnosis of symptomatic patients with a low to moderate pre‑test probability of ischemic heart disease. The present study included 46 patients with a mean age of 64 years (33 men and 13 women). Prior to the CT study, myocardial stress was pharmacologically (adenosine, n=15 and regadenoson, n=31) induced by vasodilatation of the coronary arteries. Hemodynamic parameters (myocardial blood flow) were evaluated in all patients following successful CT perfusion without complications, allergic reaction or other severe side effects. The present study revealed that regadenoson increased the heart rate following infusion with a higher magnitude compared with adenosine. Moreover, the effect of regadenoson was independent of patient's body mass index and was associated with a lower incidence of mild adverse effects. The present study provided further clinical evidence for a more wider use of regadenoson over adenosine.

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1	Yang L, Zhou T, Zhang R, Xu L, Peng Z, Ding J, Wang S, Li M and Sun G: Meta-analysis: Diagnostic accuracy of coronary CT angiography with prospective ECG gating based on step-and-shoot, Flash and volume modes for detection of coronary artery disease. Eur Radiol. 24:2345–2352. 2014.PubMed/NCBI View Article : Google Scholar
2	American College of Cardiology Foundation Task Force on Expert Consensus Documents. Mark DB, Berman DS, Budoff MJ, Carr JJ, Gerber TC, Hecht HS, Hlatky MA, Hodgson JM, Lauer MS, et al: ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: A report of the American College of cardiology foundation task force on expert consensus documents. Circulation. 121:2509–2543. 2010.PubMed/NCBI View Article : Google Scholar
3	Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O'Gara P and Rubin GD: American College of Cardiology Foundation Appropriate Use Criteria Task Force; Society of Cardiovascular Computed Tomography; American College of Radiology et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. a report of the American College of cardiology foundation appropriate use criteria task force, the society of cardiovascular computed tomography, the American college of radiology, the American heart association, the American society of echocardiography, the American Society of nuclear cardiology, the North American Society for cardiovascular imaging, the society for cardiovascular angiography and interventions, and the society for cardiovascular magnetic resonance. Circulation. 122:e525–e555. 2010.PubMed/NCBI View Article : Google Scholar
4	Bamberg F, Becker A, Schwarz F, Marcus RP, Greif M, von Ziegler F, Blankstein R, Hoffmann U, Sommer WH, Hoffmann VS, et al: Detection of hemodynamically significant coronary artery stenosis: Incremental diagnostic value of dynamic CT-based myocardial perfusion imaging. Radiology. 260:689–698. 2011.PubMed/NCBI View Article : Google Scholar
5	Botvinick EH: Current methods of pharmacologic stress testing and the potential advantages of new agents. J Nucl Med Technol. 37:14–25. 2009.PubMed/NCBI View Article : Google Scholar
6	Lette J, Tatum JL, Fraser S, Miller DD, Waters DD, Heller G, Stanton EB, Bom HS, Leppo J and Nattel S: Safety of dipyridamole testing in 73,806 patients- the multicenter dipyridamole safety study. J Nucl Cardiol. 2:3–17. 1995.PubMed/NCBI View Article : Google Scholar
7	Cerqueira MD, Verani MS, Schwaiger M, Heo J and Iskandrian AS: Safety profile of adenosine stress perfusion imaging-Results from the adenoscan-multicenter-trial-registry. J Am Coll Cardiol. 23:384–389. 1994.PubMed/NCBI View Article : Google Scholar
8	Cerqueira MD: The future of pharmacologic stress: Selective A2A adenosine receptor agonists. Am J Cardiol. 94:33D–42D. 2004.PubMed/NCBI View Article : Google Scholar
9	Hasko G, Linden J, Cronstein B and Pacher P: Adenosine receptors: Therapeutic aspects for inflammatory and immune diseases. Nat Rev Drug Discov. 7:759–770. 2008.PubMed/NCBI View Article : Google Scholar
10	Iskandrian AE, Bateman TM, Belardinelli L, Blackburn B, Cerqueira MD, Hendel RC, Lieu H, Mahmarian JJ, Olmsted A, Underwood SR, et al: Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol. 14:645–658. 2007.PubMed/NCBI View Article : Google Scholar
11	Goudarzi B, Fukushima K, Bravo P, Merrill J and Bengel FM: 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. 38:1908–1916. 2011.PubMed/NCBI View Article : Google Scholar
12	Andrikopoulou E and Hage FG: Adverse effects associated with regadenoson myocardial perfusion imaging. J Nucl Cardiol. 25:1724–1731. 2018.PubMed/NCBI View Article : Google Scholar
13	Al Jaroudi W and Iskandrian AE: Regadenoson: A new myocardial stress agent. J Am Coll Cardiol. 54:1123–1130. 2009.PubMed/NCBI View Article : Google Scholar
14	Johnson SG and Peters S: Advances in pharmacologic stress agents: Focus on regadenoson. J Nucl Med Technol. 38:163–171. 2010.PubMed/NCBI View Article : Google Scholar
15	Nous FMA, Geisler T, Kruk MBP, Alkadhi H, Kitagawa K, Vliegenthart R, Hell MM, Hausleiter J, Nguyen PK, Budde RPJ, et al: Dynamic myocardial perfusion CT for the detection of hemodynamically significant coronary artery disease. JACC Cardiovasc Imaging. 15:75–87. 2022.PubMed/NCBI View Article : Google Scholar
16	Bastarrika G, Ramos-Duran L, Rosenblum MA, Kang DK, Rowe GW and Schoepf UJ: Adenosine-stress dynamic myocardial CT perfusion imaging: Initial clinical experience. Invest Radiol. 45:306–313. 2010.PubMed/NCBI View Article : Google Scholar
17	Cury RC, Abbara S, Achenbach S, Agatston A, Berman DS, Budoff MJ, Dill KE, Jacobs JE, Maroules CD, Rubin GD, et al: CAD-RADS: Coronary artery disease-reporting and data system: An expert consensus document of the society of cardiovascular computed tomography (SCCT), the American college of radiology (ACR) and the North American society for cardiovascular imaging (NASCI). Endorsed by the American College of Cardiology. J Am Coll Radiol. 13:1458–1466 e9. 2016.PubMed/NCBI View Article : Google Scholar
18	Rossi A, Wragg A, Klotz E, Pirro F, Moon JC, Nieman K and Pugliese F: Dynamic computed tomography myocardial perfusion imaging: Comparison of clinical analysis methods for the detection of vessel-specific ischemia. Circ-Cardiovasc Imag. 10(e005505)2017.PubMed/NCBI View Article : Google Scholar
19	Reyes E, Staehr P, Olmsted A, Zeng D, Blackburn B, Cerqueira MD and Underwood SR: Effect of body mass index on the efficacy, side effect profile, and plasma concentration of fixed-dose regadenoson for myocardial perfusion imaging. J Nucl Cardiol. 18:620–627. 2011.PubMed/NCBI View Article : Google Scholar
20	Dhalla AK, Wong MY, Wang WQ, Biaggioni I and Belardinelli L: Tachycardia caused by A2A adenosine receptor agonists is mediated by direct sympathoexcitation in awake rats. J Pharmacol Exp Ther. 316:695–702. 2006.PubMed/NCBI View Article : Google Scholar
21	Lieu HD, Shryock JC, von Mering GO, Gordi T, Blackburn B, Olmsted AW, Belardinelli L and Kerensky RA: Regadenoson, a selective A2A adenosine receptor agonist, causes dose-dependent increases in coronary blood flow velocity in humans. J Nucl Cardiol. 14:514–520. 2007.PubMed/NCBI View Article : Google Scholar
22	Namdar M, Koepfli P, Grathwohl R, Siegrist PT, Klainguti M, Schepis T, Delaloye R, Wyss CA, Fleischmann SP, Gaemperli O and Kaufmann PA: Caffeine decreases exercise-induced myocardial flow reserve. J Am Coll Cardiol. 47:405–410. 2006.PubMed/NCBI View Article : Google Scholar
23	Rai M, Ahlberg AW, Marwell J, Chaudhary W, Savino JA III, Alter EL, Henzlova MJ and Duvall WL: Safety of vasodilator stress myocardial perfusion imaging in patients with elevated cardiac biomarkers. J Nucl Cardiol. 24:724–734. 2017.PubMed/NCBI View Article : Google Scholar
24	Cerqueira MD, Nguyen P, Staehr P, Underwood SR and Iskandrian AE: ADVANCE-MPI Trial Investigators. 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. 1:307–316. 2008.PubMed/NCBI View Article : Google Scholar
25	Rangel MO, Demori RM and Doukky R: Age and gender as predictors of benefit from aminophylline administration in patients undergoing regadenoson stress myocardial perfusion imaging: A substudy of the ASSUAGE trial. Am J Ther. 20:622–629. 2013.PubMed/NCBI View Article : Google Scholar
26	Katsikis A, Kyrozi E, Manira V, Theodorakos A, Malamitsi J, Tsapaki V, Iakovou I, Voudris V, Kolovou G and Koutelou M: Gender-related differences in side-effects and hemodynamic response to regadenoson in patients undergoing SPECT myocardial perfusion imaging. Eur J Nucl Med Mol Imaging. 46:2590–2600. 2019.PubMed/NCBI View Article : Google Scholar
27	Golzar Y and Doukky R: Regadenoson use in patients with chronic obstructive pulmonary disease: The state of current knowledge. Int J Chronic Obstruct Pulmon Dis. 9:129–137. 2014.PubMed/NCBI View Article : Google Scholar
28	Brink HL, Dickerson JA, Stephens JA and Pickworth KK: Comparison of the safety of adenosine and regadenoson in patients undergoing outpatient cardiac stress testing. Pharmacotherapy. 35:1117–1123. 2015.PubMed/NCBI View Article : Google Scholar