Review ArticleRegadenoson: A focused update
Section snippets
Use of REGA in Special Groups
Although REGA is excreted by the kidneys, several studies show that the drug could be used safely in patients with CKD including those on dialysis (stage 5, Table 1).9,10 Similarly, REGA could be safely used in patients with liver disease including those on the waiting list for liver transplantation (Table 1).11 With adenosine infusion in this population, we have encountered some instances of symptomatic hypotension, which we attributed to the fact that adenosine dose is adjusted for body
Hybrid Protocols
The early practice of combining exercise with dipyridamole (hybrid protocols) was used subsequently with adenosine and more recently with REGA6,17, 18, 19, 20. (Figure 1; Table 2). The primary reasons for the hybrid protocols are to decrease side effects and improve image quality. Improvement in image quality may improve the diagnostic accuracy of stress MPI but this has not been consistently proven. As discussed earlier, there is no reason to believe that MBF is higher when combining exercise
Outcome Data
We have shown that major cardiac events are infrequent in patients with normal REGA MPI; Furthermore, normal REGA MPI provides similar prognostic data to normal adenosine MPI.21 In this study, the primary composite end-point (cardiac death, myocardial infarction, and coronary revascularization) was collected for 2,000 patients (1,000 REGA and 1,000 adenosine stress) with normal myocardial perfusion and left ventricular ejection fraction referred for vasodilator MPI. In addition, propensity
Conclusion
REGA is well tolerated in patients with CKD, liver disease, and airway disease. Hybrid protocols in combination with exercise are feasible and appear to be safe with no serious side effects and a decrease in non-serious side effects. There are emerging data on the prognostic value of REGA MPI and heart rate response. These reports might explain the widespread use of REGA as the preferred vasodilator with MPI in the United States. It is too early to predict the penetration rate of REGA for MPI
Conflict of interest
Dr Iskandrian is on the advisory panel of Astellas Pharma. Drs Hage and Iskandrian report investigator-initiated grant support from Astellas Pharma. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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