Abstract
BackgroundAdenosine receptor stress agents for myocardial perfusion imaging (MPI) may cause A2B and/or A3 receptor-mediated bronchoconstriction, of particular concern to physicians testing patients with asthma or chronic obstructive pulmonary disease (COPD). MethodsA Phase 4, randomized, double-blind study (NCT00862641) assessed the safety of the selective A2A receptor agonist, regadenoson, compared with placebo in subjects with asthma or COPD who represented likely candidates for MPI. ResultsOverall, 356 and 176 subjects with asthma and 316 and 151 subjects with COPD received regadenoson and placebo, respectively. The percentage of subjects experiencing a >15% decrease in FEV1 from baseline to any assessment up to 24 hours post-baseline was not statistically significantly different between the regadenoson and the placebo groups in the asthma or COPD stratum. Dyspnea, the most frequent respiratory adverse event, occurred with higher incidence (P < .0001) in the regadenoson group than the placebo group in the asthma (10.7% vs 1.1%) and COPD (18.0% vs 2.6%) strata. No subjects experienced severe bronchoconstriction, although the occurrence of such reactions with adenosine receptor agonists cannot be ruled out, such that caution is advised. ConclusionsThis information may be helpful to physicians selecting a pharmacologic stress agent for MPI in patients with asthma or COPD.
Highlights
Myocardial perfusion imaging (MPI) is a widely used technique to aid the diagnosis and the evaluation of coronary artery disease
Study drug was administered to 999 subjects, of which 356 and 176 subjects with asthma and 316 and 151 subjects with chronic obstructive pulmonary disease (COPD) received regadenoson and placebo, respectively (Figure 1)
Baseline characteristics were generally similar between subjects who received regadenoson and subjects who received placebo in the two disease strata, subjects with COPD who received regadenoson had a statistically significantly lower mean body weight and BMI than subjects who received placebo (Table 2)
Summary
Myocardial perfusion imaging (MPI) is a widely used technique to aid the diagnosis and the evaluation of coronary artery disease. This article is published with open access at Springerlink.com doi:10.1007/s12350-012-9547-4 regadenoson increase myocardial blood flow by causing coronary vasodilation via stimulation of adenosine A2A receptors.[2] Pharmacologic stress agents that are nonselective adenosine receptor agonists activate all adenosine receptor subtypes (A1, A2A, A2B, and A3) to different extents at recommended clinical doses.[1] The activation of the A1, A2B, and A3 receptors can elicit a variety of undesirable responses including atrioventricular block (A1 receptor), peripheral vasodilation (A2B receptor), and bronchoconstriction (A2B and A3 receptors).[1] The risk of bronchoconstriction is of particular concern for physicians considering pharmacologic stress MPI in patients with asthma or chronic obstructive pulmonary disease (COPD). Adenosine receptor stress agents for myocardial perfusion imaging (MPI) may cause A2B and/or A3 receptor-mediated bronchoconstriction, of particular concern to physicians testing patients with asthma or chronic obstructive pulmonary disease (COPD)
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