Original ArticleSafety of regadenoson in patients with end-stage liver disease
Introduction
Myocardial perfusion imaging (MPI) is widely used for the detection of coronary artery disease (CAD), risk stratification, and pre-operative evaluation. Approximately half of the studies are performed with a vasodilator stress agent.1 This is particularly true in patients with end-stage liver disease (ESLD) undergoing liver transplant evaluation as these patients have limited exercise capacity. Orthotopic liver transplantation is the last hope of treatment in patients with ESLD. The number of these procedures continues to increase and the results continue to improve.2 The procedure is costly and the resources are limited and hence pre-operative screening to identify high-risk patients is often done.3 Regadenoson, unlike adenosine, is given as a fixed dose. Another relevant pharmacokinetic property of regadenoson is that it is not metabolized and predominately excreted by the kidney (55-60%), while the remaining 40% is excreted by the liver through the bile, also unchanged.4 There are no safety data of the drug in patients with ESLD. The purpose of this study is to examine the hemodynamic changes, safety, and tolerability of regadenoson in patients with ESLD.
Section snippets
Patient Selection
We identified from our database, 168 consecutive patients with ESLD who had regadenoson stress gated MPI for clinical indications from 2008 to 2010. The MPI was done before anticipated orthotopic liver transplantation. Since the majority of the patients had normal perfusion images,3,5 we selected a control group of patients with no liver disease (N = 168), from the same time period, and with comparable MPI results. The patients’ records were reviewed for demographics, co-morbidities,
Results
The baseline characteristics of the patients are listed in Table 1. The ESLD group was younger than the control group and included more Caucasians, and fewer patients with hypertension or peripheral vascular disease. The most common causes fro liver transplant were: hepatitis C (40%), non-alcoholic steatohepatitis (18%), alcohol (12%), crypotogenic (11%), primary biliary cirrhosis (6%), and alpha-1 antitrypsin deficiency (4%). Both the groups had a similar proportion of patients with diabetes
Discussion
This is the first study that documents the safety of regadenoson in patients with ESLD. Further, the changes in BP were comparable to those in the control group but the HR response was less. Blunted HR response to adenosine and regadenoson has been described by our group in patients with diabetes, metabolic syndrome, and end-stage renal disease.12,13
Most patients undergoing stress MPI for liver transplant evaluation have normal myocardial perfusion, which led some to question the benefit of
Disclosures
Dr Ami E. Iskandrian is an investigator and a consultant to Gilead Sciences, Inc. The other authors have no disclosures.
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2014, Side Effects of Drugs AnnualCitation Excerpt :Aminophylline, a non-specific adenosine receptor antagonist, may interfere with the vasodilatory activity of regadenoson and can be given intravenously to attenuate adverse reactions. Susceptibility factors Liver disease In 168 patients with end-stage liver disease, who had regadenoson stress-gated single photon emission CT before planned orthotopic liver transplantation and 168 controls, the heart rate increase in response to regadenoson was less in the patients, but the changes in systolic and diastolic blood pressures were similar; there were no deaths or medication-related adverse events that required hospitalization in either group within 30 days of the study [46C]. Lung disease In a retrospective study of 228 patients with COPD (n = 126) or asthma (n = 102) undergoing SPECT imaging with regadenoson, compared with 1142 patients without COPD or asthma, there were no cases of exacerbation of COPD or asthma after regadenoson [47C].
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2013, Pharmacology and TherapeuticsCitation Excerpt :Although regadenoson clearance varies significantly with renal function (Gordi et al., 2007), several prospective studies support the use of regadenoson without dose adjustment in all stages of renal dysfunction (Ananthasubramaniam et al., 2012; Doukky et al., 2012b, 2013). The safety of regadenoson in patients with severe hepatic disease has also been evaluated favorably (Aljaroudi et al., 2011). This flexibility is likely due to the balanced renal and hepatic clearance of regadenoson in subjects with normal renal and liver function.
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2013, Journal of Nuclear Cardiology