Regadenoson

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Rami Doukky - One of the best experts on this subject based on the ideXlab platform.

Ami E Iskandrian - One of the best experts on this subject based on the ideXlab platform.

  • risk stratification using the heart rate response to Regadenoson during mycoardial perfusion imaging in type 2 myocardial infarction
    Journal of the American College of Cardiology, 2019
    Co-Authors: Chad M Colon, Ami E Iskandrian, Ramey Marshell, Christopher Roth, Ayman A Farag, Fadi G Hage
    Abstract:

    Patients with type 2 myocardial infarction (T2MI) are at high risk of mortality and cardiovascular events. We have previously demonstrated that a blunted heart rate response (HRR) to Regadenoson is associated with increased risk of cardiovascular events in patients undergoing myocardial perfusion

  • the prognostic value of Regadenoson myocardial perfusion imaging
    Journal of Nuclear Cardiology, 2015
    Co-Authors: Fadi G Hage, Gopal Ghimire, Davis Lester, Joshua Mckay, Steven Bleich, Stephanie Elhajj, Ami E Iskandrian
    Abstract:

    Background Regadenoson (REGA), a selective adenosine A2A receptor agonist, is the most widely used stress agent for SPECT myocardial perfusion imaging (MPI) in the United States. The diagnostic accuracy of REGA MPI is comparable to Adenosine MPI, but its prognostic value is not well defined.

  • reclassification of cardiovascular risk in patients with normal myocardial perfusion imaging using heart rate response to vasodilator stress
    American Journal of Cardiology, 2013
    Co-Authors: Fahad M Iqbal, Ami E Iskandrian, Jaekyeong Heo, Wael Al Jaroudi, Kumar Sanam, Aaron Sweeney, Fadi G Hage
    Abstract:

    Previous studies have shown that patients with normal vasodilator myocardial perfusion imaging (MPI) findings remain at a greater risk of future cardiac events than patients with normal exercise MPI findings. The aim was to assess improvement in risk classification provided by the heart rate response (HRR) in patients with normal vasodilator MPI findings when added to traditional risk stratification. We retrospectively studied 2,000 patients with normal Regadenoson or adenosine MPI findings. Risk stratification was performed using Adult Treatment Panel III framework. Patients were stratified by HRR (percentage of increase from baseline) into tertiles specific to each vasodilator. All-cause mortality and cardiac death/nonfatal myocardial infarction (MI) ≤2 years from the index MPI were recorded. During follow-up, 11.8% patients died and 2.7% patients experienced cardiac death/nonfatal MI in the adenosine and Regadenoson groups, respectively. The patients who died had a greater Framingham risk score (12 ± 4 vs 11 ± 4, p = 0.009) and lower HRR (22 ± 16 vs 32 ± 21, p

  • a blunted heart rate response to Regadenoson is an independent prognostic indicator in patients undergoing myocardial perfusion imaging
    Journal of Nuclear Cardiology, 2011
    Co-Authors: Fadi G Hage, Phillip Dean, Fahad M Iqbal, Jaekyeong Heo, Ami E Iskandrian
    Abstract:

    Regadenoson myocardial perfusion imaging (MPI) is a useful method for risk assessment. We hypothesized that the heart rate response (HRR) to Regadenoson carries incremental prognostic information to that derived from perfusion pattern and left ventricular (LV) ejection fraction (EF). The study population included 1,156 (60 ± 13 years, 46% women, 40% diabetes mellitus, 53% chronic kidney disease) patients. During a follow-up period of 22 ± 5 months, 103 patients died (9%). Independent determinants of the HRR included age, gender, race, diabetes mellitus, coronary revascularization, LVEF, use of insulin and aldosterone antagonists. Decreasing HRR was associated with stepwise increase in mortality (log-rank P < .0001). In a Cox proportional model for mortality that adjusted for age, gender, diabetes mellitus, renal disease, and MPI findings, HRR in the lowest quartile was independently associated with fivefold increase in mortality compared to the highest quartile [HR 5.2, 95% CI 2.3-12.0, P < .0001]. Patients with a normal HRR had a relatively low annualized total mortality despite the presence of risk factors. The addition of HRR to traditional MPI findings had a net reclassification improvement of 15%, P = .02. A blunted HRR to Regadenoson is an independent predictor of poor outcome, adds incremental value to MPI, and helps in better risk stratification.

  • heart rate response during vasodilator stress myocardial perfusion imaging mechanisms and implications
    Journal of Nuclear Cardiology, 2010
    Co-Authors: Fadi G Hage, Ami E Iskandrian
    Abstract:

    Myocardial perfusion imaging (MPI) using adenosine, dipyridamole, or Regadenoson (a selective A2A receptor agonist) is an established method for detecting coronary artery disease (CAD) and risk stratification. In high-risk populations, as in those with diabetes mellitus (DM) or chronic kidney disease, MPI has been shown to be a powerful predictor of risk, but nevertheless, patients with normal myocardial perfusion are at higher risk than those without DM or chronic kidney disease. Thus, there continues to be a need to extract more useful prognostic data from stress MPI especially in high-risk populations. A blunted heart rate (HR) response to exercise stress has been known to be an independent predictor of poor outcome and is used clinically in conjunction with other prognostic variables such as perfusion defects, left ventricular (LV) ejection fraction (EF) and volumes, exercise time, and symptoms during exercise to derive an overall assessment of risk in a particular patient. In patients undergoing stress testing, for one reason or another, with adenosine or Regadenoson (and dipyridamole, which acts indirectly by increasing interstitial levels of endogenous adenosine), there is a modest increase in HR and a modest decrease in blood pressure (BP). The increase in HR has been traditionally attributed to a reflex response to the vasodilatory effect on the systemic circulation and the resultant increase in sympathetic discharge. The true mechanism of HR increase, however, is more complicated and involves direct stimulation of the sympathetic nervous system. The administration of adenosine as a bolus, as done for the interruption of supra-ventricular tachycardias, has a negative chronotropic effect on the atrio-ventricular node via stimulation of the A1 receptor. This is in contradistinction to its effect on the A2A receptor when given as an infusion in stress MPI studies where it induces an increase in HR. The development of selective A2A receptor agonists (such as Regadenoson) has allowed for the dissection of the effects of adenosine on the multiple receptors. A well-done pivotal study in rats by Dhalla et al that used Regadenoson in combination with a selective A2A receptor antagonist, B-blocker, a ganglionic blocker (to block the sympathetic nervous system), and a direct vasodilator (nitroprusside) demonstrated the dissociation of tachycardia and hypotension (secondary to peripheral vasodilation) responses to Regadenoson. This and other data (reviewed in Ref. ) confirm that A2A receptor agonists cause a direct stimulation of the autonomic nervous system, which results in sinus tachycardia independent of the baroreflex mechanism. Thus, the change in HR in response to A2A receptor agonists can be used to evaluate autonomic function. In order to evaluate the HR response to adenosine and Regadenoson in relation to DM (since there is a high prevalence of autonomic dysfunction in patients with DM), we used data from the ADenoscan Versus Regadenoson Comparative Evaluation for Myocardial Perfusion Imaging (ADVANCE MPI 1 and 2) Trials. The ADVANCE MPI Trials are randomized multicenter phase 3 trials that demonstrated the noninferiority of Regadenoson to adenosine in detecting reversible defects by comparing the strength of agreement between sequential adenosine-Regadenoson and adenosine-adenosine images. The HR and BP were measured at baseline and at predetermined intervals extending to 45 minutes after the administration of adenosine or Regadenoson. In the 2,000 patients with known DM status (643 with DM, 1357 non-DM, 15 unknown DM status) there was a blunted HR response (maximal percent change of HR from baseline) in those From the Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL; Section of Cardiology, Birmingham Veteran’s Administration Medical Center, Birmingham, AL. Reprint requests: Fadi G. Hage, MD, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Zeigler Research Building 1024, 1530 3rd AVE S, Birmingham, AL 35294-0006; fadihage@uab.edu. J Nucl Cardiol 2010;17:536–9. 1071-3581/$34.00 Copyright 2010 by the American Society of Nuclear Cardiology. doi:10.1007/s12350-010-9248-9

Manuel D Cerqueira - One of the best experts on this subject based on the ideXlab platform.

  • effect of body mass index on the efficacy side effect profile and plasma concentration of fixed dose Regadenoson for myocardial perfusion imaging
    Journal of Nuclear Cardiology, 2011
    Co-Authors: Eliana Reyes, Brent Blackburn, Ann Olmsted, Manuel D Cerqueira, Peter Staehr, Dewan Zeng, Richard S Underwood
    Abstract:

    Background There are limited data on the effect of body mass index (BMI) on the actions of fixed-dose Regadenoson. The purpose of this study was to determine the effect of BMI on the efficacy, side effects, and plasma concentration of Regadenoson for Myocardial Perfusion Imaging (MPI).

  • 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-cardiovascular Imaging, 2008
    Co-Authors: Manuel D Cerqueira, Ami E Iskandrian, Richard S Underwood, Peter Staehr, Patricia K Nguyen, Advancempi Trial Investigators
    Abstract:

    Objectives To compare the effects of age, gender, body mass index, and diabetes on the safety and efficacy of Regadenoson stress myocardial perfusion imaging, and to assess the noninferiority of Regadenoson to adenosine for the detection of reversible myocardial perfusion defects. Background Previous reports have shown that a fixed unit bolus of Regadenoson is safe and noninferior to adenosine for the detection of reversible perfusion defects by radionuclide imaging. Methods Using a database of 2,015 patients, we evaluated the effects of age, gender, body mass index, and diabetes on the safety and efficacy of Regadenoson compared to adenosine. Results For detection of ischemia relative to adenosine, noninferiority was demonstrated for all patients (agreement rate difference 0%, 95% CI −6.2% to +6.8%). The average agreement rate between adenosine-adenosine and adenosine-Regadenoson were 0.62 ± 0.03 and 0.63 ± 0.02. Detection of ischemia was also comparable in specific subgroups. Agreement was less for both agents in women versus men with moderate and large areas of ischemia. Compared to adenosine, Regadenoson had a lower combined symptom score and less chest pain, flushing, and throat, neck, or jaw pain, but more headache and gastrointestinal discomfort. This was true in nearly all subgroups. Regadenoson patients reported feeling more comfortable (1.7 ± .02 vs. 1.9 ± 0.03, p Conclusions Regadenoson can be safely administered as a fixed unit bolus and is as efficacious as adenosine in detecting ischemia regardless of age, gender, body mass index, and diabetes. Regadenoson is better tolerated overall and across various subgroups.

  • adenosine versus Regadenoson comparative evaluation in myocardial perfusion imaging results of the advance phase 3 multicenter international trial
    Journal of Nuclear Cardiology, 2007
    Co-Authors: Ami E Iskandrian, Brent Blackburn, Ann Olmsted, Luiz Belardinelli, Robert C Hendel, Manuel D Cerqueira, Timothy M Bateman, Hsiao Lieu, John J Mahmarian, Richard S Underwood
    Abstract:

    Background Earlier phase 1 and 2 studies have shown that Regadenoson has desirable features as a stress agent for myocardial perfusion imaging. Methods and Results This multicenter, double-blinded phase 3 trial involved 784 patients at 54 sites. Each patient underwent 2 sets of gated single photon emission computed tomography myocardial perfusion imaging studies: an initial qualifying study with adenosine and a subsequent randomized study with either Regadenoson (2/3 of patients) or adenosine. Regadenoson was administered as a rapid bolus ( P = .013). Conclusions This phase 3 trial shows that Regadenoson provides diagnostic information comparable to a standard adenosine infusion. There were no serious drug-related side effects, and Regadenoson was better tolerated than adenosine.

  • initial clinical experience with Regadenoson a novel selective a2aagonist for pharmacologic stress single photon emission computed tomography myocardial perfusion imaging
    Journal of the American College of Cardiology, 2005
    Co-Authors: Robert C Hendel, Brent Blackburn, Ami E Iskandrian, Manuel D Cerqueira, Timothy M Bateman, Jeffrey A Leppo, John J Mahmarian
    Abstract:

    Initial Clinical Experience With Regadenoson, a Novel Selective A2AAgonist for Pharmacologic Stress Single-Photon Emission Computed Tomography Myocardial Perfusion ImagingRobert C. Hendel, Timothy ...

Fadi G Hage - One of the best experts on this subject based on the ideXlab platform.

  • incidence of atrioventricular block with vasodilator stress spect a meta analysis
    Journal of Nuclear Cardiology, 2019
    Co-Authors: Efstathia Andrikopoulou, Charity J Morga, Lizbeth R Ice, Navkaranbi S Ajaj, Harish Doppalapudi, Ami E Iskandria, Fadi G Hage
    Abstract:

    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. 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. 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. 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.

  • risk stratification using the heart rate response to Regadenoson during mycoardial perfusion imaging in type 2 myocardial infarction
    Journal of the American College of Cardiology, 2019
    Co-Authors: Chad M Colon, Ami E Iskandrian, Ramey Marshell, Christopher Roth, Ayman A Farag, Fadi G Hage
    Abstract:

    Patients with type 2 myocardial infarction (T2MI) are at high risk of mortality and cardiovascular events. We have previously demonstrated that a blunted heart rate response (HRR) to Regadenoson is associated with increased risk of cardiovascular events in patients undergoing myocardial perfusion

  • the prognostic value of Regadenoson myocardial perfusion imaging
    Journal of Nuclear Cardiology, 2015
    Co-Authors: Fadi G Hage, Gopal Ghimire, Davis Lester, Joshua Mckay, Steven Bleich, Stephanie Elhajj, Ami E Iskandrian
    Abstract:

    Background Regadenoson (REGA), a selective adenosine A2A receptor agonist, is the most widely used stress agent for SPECT myocardial perfusion imaging (MPI) in the United States. The diagnostic accuracy of REGA MPI is comparable to Adenosine MPI, but its prognostic value is not well defined.

  • reclassification of cardiovascular risk in patients with normal myocardial perfusion imaging using heart rate response to vasodilator stress
    American Journal of Cardiology, 2013
    Co-Authors: Fahad M Iqbal, Ami E Iskandrian, Jaekyeong Heo, Wael Al Jaroudi, Kumar Sanam, Aaron Sweeney, Fadi G Hage
    Abstract:

    Previous studies have shown that patients with normal vasodilator myocardial perfusion imaging (MPI) findings remain at a greater risk of future cardiac events than patients with normal exercise MPI findings. The aim was to assess improvement in risk classification provided by the heart rate response (HRR) in patients with normal vasodilator MPI findings when added to traditional risk stratification. We retrospectively studied 2,000 patients with normal Regadenoson or adenosine MPI findings. Risk stratification was performed using Adult Treatment Panel III framework. Patients were stratified by HRR (percentage of increase from baseline) into tertiles specific to each vasodilator. All-cause mortality and cardiac death/nonfatal myocardial infarction (MI) ≤2 years from the index MPI were recorded. During follow-up, 11.8% patients died and 2.7% patients experienced cardiac death/nonfatal MI in the adenosine and Regadenoson groups, respectively. The patients who died had a greater Framingham risk score (12 ± 4 vs 11 ± 4, p = 0.009) and lower HRR (22 ± 16 vs 32 ± 21, p

  • a blunted heart rate response to Regadenoson is an independent prognostic indicator in patients undergoing myocardial perfusion imaging
    Journal of Nuclear Cardiology, 2011
    Co-Authors: Fadi G Hage, Phillip Dean, Fahad M Iqbal, Jaekyeong Heo, Ami E Iskandrian
    Abstract:

    Regadenoson myocardial perfusion imaging (MPI) is a useful method for risk assessment. We hypothesized that the heart rate response (HRR) to Regadenoson carries incremental prognostic information to that derived from perfusion pattern and left ventricular (LV) ejection fraction (EF). The study population included 1,156 (60 ± 13 years, 46% women, 40% diabetes mellitus, 53% chronic kidney disease) patients. During a follow-up period of 22 ± 5 months, 103 patients died (9%). Independent determinants of the HRR included age, gender, race, diabetes mellitus, coronary revascularization, LVEF, use of insulin and aldosterone antagonists. Decreasing HRR was associated with stepwise increase in mortality (log-rank P < .0001). In a Cox proportional model for mortality that adjusted for age, gender, diabetes mellitus, renal disease, and MPI findings, HRR in the lowest quartile was independently associated with fivefold increase in mortality compared to the highest quartile [HR 5.2, 95% CI 2.3-12.0, P < .0001]. Patients with a normal HRR had a relatively low annualized total mortality despite the presence of risk factors. The addition of HRR to traditional MPI findings had a net reclassification improvement of 15%, P = .02. A blunted HRR to Regadenoson is an independent predictor of poor outcome, adds incremental value to MPI, and helps in better risk stratification.

Brent Blackburn - One of the best experts on this subject based on the ideXlab platform.

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