Safety of regadenoson as a pharmacologic stress agent for myocardial perfusion imaging in chronic kidney disease patients not on hemodialysis

Gurunanthan Palani, Zehra Husain, Rafael Cabrera Salinas, Vanji Karthikeyan, Aarthee S. Karthikeyan, Karthik Ananthasubramaniam

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Pharmacokinetic studies suggest delayed clearance of Regadenoson (REG), a new selective A2A receptor agonist in chronic kidney disease (CKD). The safety of REG in large series of CKD patients in daily clinical practice remains unstudied. Methods: Retrospective study of patients with eGFR < 60 mL/min (n = 411, Grp 1, CKD) were compared to patients with eGFR ≥ 60 mL/min (n = 638, Grp 2, Control) undergoing REG-SPECT from Jan to Nov 2009. Patient demographics, REG-SPECT data, side effects, and arrhythmia occurrences were evaluated. Results: No major adverse events were noted immediately after REG-SPECT or at 1 week of follow-up. There were no differences in any arrhythmias in between the two groups (Grp 1, 47.2% vs Grp 2, 42.9%, P = ns). Ninety-nine percent of arrhythmias in CKD patients were PACs or PVCs. Transient junctional rhythm was observed in one CKD patient. There were no occurrences of second degree or higher degree AV block. Grp 1 had a blunted heart rate response (16.6 ± 16.1 vs 24.9 ± 20.3 bpm, P ≤ .001) and greater systolic blood pressure drop response (-7.4 ± 21.1 vs -1.4 ± 20.9 mm Hg, P ≤ .001) compared to Grp 2. Transient headache was more in Grp 2 (15.8% vs 22.6%, P ≤ .007). Aminophylline use to ward-off the side effects was comparable (9.5% vs 9.9%, P = ns). Conclusion: REG-SPECT can be safely performed in CKD non-dialysis patients with excellent tolerability, minimal side effects, and favorable hemodynamic responses compared to control group.

Original languageEnglish (US)
Pages (from-to)605-611
Number of pages7
JournalJournal of Nuclear Cardiology
Volume18
Issue number4
DOIs
StatePublished - Aug 1 2011

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Myocardial Perfusion Imaging
Chronic Renal Insufficiency
Renal Dialysis
Safety
Single-Photon Emission-Computed Tomography
Cardiac Arrhythmias
Blood Pressure
Aminophylline
Atrioventricular Block
regadenoson
Polyvinyl Chloride
Headache
Retrospective Studies
Pharmacokinetics
Heart Rate
Hemodynamics
Demography
Control Groups

Keywords

  • MPI in chronic kidney disease patients
  • Regadenoson A2A adenosine receptor agonists
  • hemodynamic alterations in Reg
  • myocardial perfusion imaging: SPECT

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Safety of regadenoson as a pharmacologic stress agent for myocardial perfusion imaging in chronic kidney disease patients not on hemodialysis. / Palani, Gurunanthan; Husain, Zehra; Salinas, Rafael Cabrera; Karthikeyan, Vanji; Karthikeyan, Aarthee S.; Ananthasubramaniam, Karthik.

In: Journal of Nuclear Cardiology, Vol. 18, No. 4, 01.08.2011, p. 605-611.

Research output: Contribution to journalArticle

Palani, Gurunanthan ; Husain, Zehra ; Salinas, Rafael Cabrera ; Karthikeyan, Vanji ; Karthikeyan, Aarthee S. ; Ananthasubramaniam, Karthik. / Safety of regadenoson as a pharmacologic stress agent for myocardial perfusion imaging in chronic kidney disease patients not on hemodialysis. In: Journal of Nuclear Cardiology. 2011 ; Vol. 18, No. 4. pp. 605-611.
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abstract = "Background: Pharmacokinetic studies suggest delayed clearance of Regadenoson (REG), a new selective A2A receptor agonist in chronic kidney disease (CKD). The safety of REG in large series of CKD patients in daily clinical practice remains unstudied. Methods: Retrospective study of patients with eGFR < 60 mL/min (n = 411, Grp 1, CKD) were compared to patients with eGFR ≥ 60 mL/min (n = 638, Grp 2, Control) undergoing REG-SPECT from Jan to Nov 2009. Patient demographics, REG-SPECT data, side effects, and arrhythmia occurrences were evaluated. Results: No major adverse events were noted immediately after REG-SPECT or at 1 week of follow-up. There were no differences in any arrhythmias in between the two groups (Grp 1, 47.2{\%} vs Grp 2, 42.9{\%}, P = ns). Ninety-nine percent of arrhythmias in CKD patients were PACs or PVCs. Transient junctional rhythm was observed in one CKD patient. There were no occurrences of second degree or higher degree AV block. Grp 1 had a blunted heart rate response (16.6 ± 16.1 vs 24.9 ± 20.3 bpm, P ≤ .001) and greater systolic blood pressure drop response (-7.4 ± 21.1 vs -1.4 ± 20.9 mm Hg, P ≤ .001) compared to Grp 2. Transient headache was more in Grp 2 (15.8{\%} vs 22.6{\%}, P ≤ .007). Aminophylline use to ward-off the side effects was comparable (9.5{\%} vs 9.9{\%}, P = ns). Conclusion: REG-SPECT can be safely performed in CKD non-dialysis patients with excellent tolerability, minimal side effects, and favorable hemodynamic responses compared to control group.",
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AU - Salinas, Rafael Cabrera

AU - Karthikeyan, Vanji

AU - Karthikeyan, Aarthee S.

AU - Ananthasubramaniam, Karthik

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