Oleksiak Anna, Kruk Mariusz, Śpiewak Mateusz, Miłosz-Wieczorek Barbara, Marczak Magdalena, Demkow Marcin, Kępka Cezary
Department of Intensive CardiacTherapy, National Institute of Cardiology, Warsaw, Poland.
Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warsaw, Poland
Kardiol Pol. 2020 Aug 25;78(7-8):709-714. doi: 10.33963/KP.15356. Epub 2020 May 12.
The use of regadenoson in dynamic computed tomography perfusion (CTP) and magnetic resonance myocardial perfusion imaging (MR MPI) is off‑label.
The study aimed to assess the safety of regadenoson with theophylline reversal during CTP and MR MPI in patients with coronary artery disease (CAD).
In this prospective study, patients with 1 or more intermediate coronary artery stenoses on computed tomography angiography underwent CTP and MR MPI with 0.4 mg of regadenoson. After examinations, 200 mg of theophylline was given intravenously in 100 ml of saline. Changes in blood pressure (BP) and heart rate (HR) were repeatedly assessed. All side effects and adverse events were recorded.
Out of 106 examinations in 53 patients (25 females, 63.5 [8.5] years), all were diagnostic. There were no deaths, myocardial infarctions, severe arrhythmias, high‑grade atrioventricular blocks, or bronchospasms. The most common symptoms were palpitations (17%), hot flushing (8%), chest discomfort (4%), and mild dyspnea (3%). There were no differences between baseline and peak BP. There was an increase in median (interquartile range) peak HR after regadenoson as compared with baseline (MR MPI, 63 [59-75] bpm vs 93 [86-102] bpm; P <0.001; and CTP, 65 [60-70] bpm vs 95 [86-107] bpm; P <0.001). The hemodynamic response to regadenoson and its side effects were completely reversible by theophylline.
Regadenoson may be a safe vasodilator for CTP and MR MPI in patients with CAD. The administration of theophylline after perfusion is safe and reverses side effects of regadenoson.
在动态计算机断层扫描灌注（CTP）和磁共振心肌灌注成像（MR MPI）中使用瑞加诺生属于超说明书用药。
本研究旨在评估冠心病（CAD）患者在CTP和MR MPI检查期间使用瑞加诺生并采用氨茶碱进行逆转的安全性。
在这项前瞻性研究中，计算机断层扫描血管造影显示有1处或多处中度冠状动脉狭窄的患者接受了CTP和MR MPI检查，使用剂量为0.4毫克的瑞加诺生。检查结束后，将200毫克氨茶碱加入100毫升生理盐水中静脉注射。反复评估血压（BP）和心率（HR）的变化。记录所有副作用和不良事件。
53例患者（25例女性，年龄63.5 [8.5]岁）共进行了106次检查，所有检查均具有诊断价值。未发生死亡、心肌梗死、严重心律失常、高度房室传导阻滞或支气管痉挛。最常见的症状为心悸（17%）、潮热（8%）、胸部不适（4%）和轻度呼吸困难（3%）。基线血压和峰值血压之间无差异。与基线相比，瑞加诺生给药后心率中位数（四分位间距）峰值升高（MR MPI，63 [59 - 75]次/分钟 vs 93 [86 - 102]次/分钟；P < 0.001；CTP，65 [60 - 70]次/分钟 vs 95 [86 - 107]次/分钟；P < 0.001）。氨茶碱可使瑞加诺生的血流动力学反应及其副作用完全逆转。
对于CAD患者，瑞加诺生可能是CTP和MR MPI检查中一种安全的血管扩张剂。灌注后给予氨茶碱是安全的，且可逆转瑞加诺生的副作用。
