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. 2019 Jan 24;21(1):9.
doi: 10.1186/s12968-018-0515-2.

Safety and prognostic value of regadenoson stress cardiovascular magnetic resonance imaging in heart transplant recipients

Felipe Kazmirczak  1 , Prabhjot S Nijjar  1 , Lei Zhang  2 , Andrew Hughes  3 , Ko-Hsuan Amy Chen  1 , Osama Okasha  1 , Cindy M Martin  1 , Mehmet Akçakaya  4 , Afshin Farzaneh-Far  5 , Chetan Shenoy  6
Affiliations

Safety and prognostic value of regadenoson stress cardiovascular magnetic resonance imaging in heart transplant recipients

Felipe Kazmirczak et al. J Cardiovasc Magn Reson. .

Abstract

Background: There is a critical need for non-invasive methods to detect coronary allograft vasculopathy and to risk stratify heart transplant recipients. Vasodilator stress testing using cardiovascular magnetic resonance imaging (CMR) is a promising technique for this purpose. We aimed to evaluate the safety and the prognostic value of regadenoson stress CMR in heart transplant recipients.

Methods: To evaluate the safety, we assessed adverse effects in a retrospective matched cohort study of consecutive heart transplant recipients who underwent regadenoson stress CMR matched in a 2:1 ratio to age- and gender-matched non-heart transplant patients. To evaluate the prognostic value, we compared the outcomes of patients with abnormal vs. normal regadenoson stress CMRs using a composite endpoint of myocardial infarction, percutaneous intervention, cardiac hospitalization, retransplantation or death.

Results: For the safety analysis, 234 regadenoson stress CMR studies were included - 78 performed in 57 heart transplant recipients and 156 performed in non-heart transplant patients. Those in heart transplant recipients were performed at a median of 2.74 years after transplantation. Thirty-four (44%) CMR studies were performed in the first two years after heart transplantation. There were no differences in the rates of adverse effects between heart transplant recipients and non-heart transplant patients. To study the prognostic value of regadenoson stress CMRs, 20 heart transplant recipients with abnormal regadenoson stress CMRs were compared to 37 with normal regadenoson stress CMRs. An abnormal regadenoson stress CMR was associated with a significantly higher incidence of the composite endpoint compared with a normal regadenoson stress CMR (3-year cumulative incidence estimates of 32.1% vs. 12.7%, p = 0.034).

Conclusions: Regadenoson stress CMR is safe and well tolerated in heart transplant recipients, with no incidence of sinus node dysfunction or high-degree atrioventricular block, including in the first two years after heart transplantation. An abnormal regadenoson stress CMR identifies heart transplant recipients at a higher risk for major adverse cardiovascular events.

Keywords: Cardiovascular magnetic resonance; Regadenoson; Safety; Stress perfusion; Vasodilator.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by University of Minnesota’s Institutional Review Board with a waiver of informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Example images of heart transplant recipients from the study. Panel a shows a patient with a decreased left ventricular (LV) ejection fraction of 41% and ischemia in multiple coronary artery territories without late gadolinium enhancement. The patient had no adverse effects from the stress CMR and on follow-up underwent multiple percutaneous interventions and eventually a retransplantation. Panel b shows a patient with a normal LV ejection fraction of 55%, no ischemia and no late gadolinium enhancement. The patient had no adverse effects from the stress CMR and on follow-up had no events
Fig. 2
Fig. 2
Incidence of composite endpoints according to abnormal vs. normal regadenoson stress CMRs. Panel a outlines the rates of the composite endpoint according to abnormal vs. normal regadenoson stress CMRs. Kaplan-Meier curves in Panel b demonstrate that cumulative incidence estimate of the composite endpoint is significantly higher in patients with abnormal vs. normal regadenoson stress CMRs
See this image and copyright information in PMC

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