Beslic Nermina, Milardovic Renata, Sadija Amera, Ceric Sejla, Raic Zeljka
Clinic of Nuclear Medicine, University-Clinical Center Sarajevo, Sarajevo, BiH.
Clinic of Cardiology, University-Clinical Center Sarajevo, Sarajevo, BiH.
Acta Inform Med. 2016 Dec;24(6):405-408. doi: 10.5455/aim.2016.24.405-408.
Myocardial perfusion imaging (MPI) is widely used in the evaluation of known and suspected coronary artery disease (CAD). Imaging of heart in stress and rest enables the comparison of myocardial uptake of radiotracer in proportion to the needs and coronary flow, which is used for detection of perfusion defects. Exercise stress and pharmacologic agents are used for the stressing purpose. Novel pharmacologic stressor regadenoson is A2A selective adenosine agonist, which selectively binds to the adenosine receptors in coronary arteries causing coronary dilatation.
We analyzed 50 myocardial perfusion studies performed with regadenoson as a pharmacologic agent that was injected before Tc99m-sestamibi in stress imaging. Stress and rest sets of images were evaluated for relative uptake of Tc99m-sestamibi in order to detect and characterize perfusion defects. After the injection of regadenoson, hemodynamic parameters and potential side-effects were closely monitored. Side-effects were stratified per severity as mild, moderate and severe. Studies were read by nuclear medicine physicians using quantitative perfusion SPECT software. Additional diagnostic information such as wall motion and wall thickening were provided by gating.
Thirty-three patients (66%) experienced one or more side-effects upon the administration of regadenoson, most commonly warmth and chest discomfort. In all patients but one (98%), the symptoms were mild, of short duration and self-limiting. Out of all side-effects registered, 44 (96%) were mild, and 2 (4%) were moderate. Two moderate side-effects developed in one patient with a prior history of asthma, and included shortness of breath and cough. Heart rate changed by 16 +- 31 bpm. Highest increase in blood pressure was 30 mm Hg for systolic, and 10 mm Hg for diastolic. One case of significant decrease in blood pressure was noted from the hypertensive basal values, 50 mm for systolic, and 30 mm Hg for diastolic. ST segment depression of up to 1 mm occurred in 4 cases (8%), and T-wave changes in 3 cases (6%). No conduction abnormalities, significant hypotension, symptomatic bradycardia or cardiac arrest ocurred.
Our first institutional experiences proved regadenoson as A2A selective adenosine agonist as a pharmacologic stressor to be safe, tolerable and easily used. Its safety profile enabled the study to be performed in patients with respiratory disease also.
心肌灌注成像（MPI）广泛应用于已知和疑似冠状动脉疾病（CAD）的评估。在负荷和静息状态下对心脏进行成像，能够比较心肌对放射性示踪剂的摄取情况与心肌需求及冠状动脉血流的比例关系，用于检测灌注缺损。运动负荷和药物制剂用于负荷试验。新型药物负荷剂瑞加诺生是一种A2A选择性腺苷激动剂，它选择性地与冠状动脉中的腺苷受体结合，引起冠状动脉扩张。
我们分析了50例使用瑞加诺生作为药物制剂的心肌灌注研究，在负荷成像时于注射锝99m - sestamibi之前注射瑞加诺生。评估负荷和静息状态下的图像，以检测和描述锝99m - sestamibi的相对摄取情况，从而检测灌注缺损。注射瑞加诺生后，密切监测血流动力学参数和潜在的副作用。副作用按严重程度分为轻度、中度和重度。研究由核医学医师使用定量灌注SPECT软件进行解读。门控提供了诸如室壁运动和室壁增厚等额外的诊断信息。
33例患者（66%）在注射瑞加诺生后出现一种或多种副作用，最常见的是潮热和胸部不适。除1例患者（98%）外，所有患者的症状均为轻度，持续时间短且可自行缓解。在所有记录的副作用中，44例（96%）为轻度，2例（4%）为中度。1例有哮喘病史的患者出现了2例中度副作用，包括呼吸急促和咳嗽。心率变化为16±31次/分钟。收缩压最高升高30 mmHg，舒张压最高升高10 mmHg。1例高血压患者的血压从基础值显著下降，收缩压下降50 mmHg，舒张压下降30 mmHg。4例患者（8%）出现ST段压低达1 mm，3例患者（6%）出现T波改变。未发生传导异常、显著低血压、症状性心动过缓或心脏骤停。
我们机构的首次经验证明，瑞加诺生作为一种A2A选择性腺苷激动剂，作为药物负荷剂是安全、可耐受且易于使用的。其安全性使得该研究也能够在患有呼吸系统疾病的患者中进行。
