Safety and tolerability of regadenoson CMR

Abstract

Aims: Knowledge of adverse events associated with regadenoson perfusion cardiac magnetic resonance (CMR) and patient tolerability has implications for patient safety and staff training. We sought to assess the safety and tolerability of regadenoson stress CMR.

Materials and methods: A group of 728 consecutive patients (median age 58, 44% female) and 25 normal volunteers (median age 21, 24% female) were recruited from August 2009 to March 2012 using a prospective, cross-sectional study design. Subjects were stressed using fixed-dose regadenoson and imaged using a 1.5T MRI scanner. Symptoms and adverse events including death, myocardial infarction (MI), ventricular tachycardia (VT)/ventricular fibrillation (VF), hospitalization, arrhythmias, and haemodynamic stability were assessed.

Results: There were no occurrences of death, MI, VT/VF, high-grade atrioventricular block, or stress-induced atrial fibrillation. Notable adverse events included one case of bronchospasm and one case of heart failure exacerbation resulting in hospitalization. The most common symptoms in patients were dyspnoea (30%, n = 217), chest discomfort (27%, n = 200), and headache (15%, n = 111). There was minimal change between baseline and peak systolic and diastolic blood pressure in both patients and volunteers (P > 0.05). A blunted heart rate response to regadenoson was noted in patients with body mass index (BMI) ≥ 30 kg/m(2) (P < 0.001), and diabetes (P = 0.001).

Conclusions: Regadenoson CMR is well tolerated and can be performed safely with few adverse events.

Keywords: Cardiovascular MRI; Coronary artery disease; Myocardial perfusion; Perfusion imaging; Regadenoson; Vasodilator agents.

Figure 1

Regadenoson perfusion imaging protocol. sec (s), second (s); min (s), minute (s).

Figure 2

Recruitment of subjects. AV, atrioventricular; CMR, cardiac magnetic resonance imaging.

Figure 3

Frequency of symptoms reported by patients and normal volunteers. Abd, abdominal; CP nitro, chest pain requiring nitroglycerine; CP MTP, chest pain requiring metoprolol.

Figure 4

Haemodynamic response with regadenoson. Values reported are medians. Error bars represent the inter-quartile range. Systolic and diastolic BP response among patient subgroups was not statistically significant (P > 0.05). BMI, body mass index; BP, blood pressure.

Figure 5

Box-and-Whisker plot of median heart rate response in patient subgroups. Differences between patient subgroups were evaluated using the Mann–Whitney U test. The height of the box represents the inter-quartile range. The middle horizontal line in the box represents the median. Whiskers (error bars) extending from the box represent minimum–maximum values. Circles represent data points. BMI, body mass index.