Abstract
Coronary artery disease (CAD) is a leading cause of death and morbidity globally. Myocardial perfusion scintigraphy (MPS) is commonly used for the diagnosis of CAD, necessitating hyperaemia achieved either by physical exertion or by pharmacological stress, most commonly through use of a coronary arteriolar dilator. This is challenging in patients with respiratory conditions because exercise may be submaximal and adenosine is contraindicated because of the risk of bronchoconstriction. Regadenoson is the only selective adenosine A2A receptor agonist approved as a vasodilator in MPS. The risk of bronchospasm with regadenoson has been investigated in large, randomised trials; however, patients with the most severe respiratory conditions were not included. In this case series, we present the use of regadenoson MPS in five patients with moderate-to-severe lung conditions, including patients requiring lung volume reduction surgery and lung transplant. In all cases, regadenoson MPS provided valuable information for risk assessment and treatment optimisation. Although dyspnoea occurred in all patients, regadenoson was well tolerated without serious adverse events or bronchospasm; in no case was intervention required to treat dyspnoea.
Highlights
Coronary artery disease (CAD) is a global health issue and the leading cause of death and morbidity worldwide.[1]
A 75-year-old woman with a history of INTERSTITIAL LUNG DISEASE (ILD) secondary to undifferentiated connective tissue disease and pulmonary hypertension presented with palpitation, breathlessness and recent impairment in left ventricular function (LVEF had decreased from 50 to 35% on echocardiography)
A 12-month clinical review was scheduled to re-assess the indication for LVRS. This series of cases confirms the suitability of regadenoson stress for Myocardial perfusion scintigraphy (MPS) without significant adverse events in patients with severe lung disease and with pulmonary hypertension
Summary
Coronary artery disease (CAD) is a global health issue and the leading cause of death and morbidity worldwide.[1]. Stress was performed with regadenoson and bicycle ergometer exercise at 0 Watts His heart rate increased from 109 to 123 bpm, and blood pressure changed from 135/85 to 140/70 mmHg, whereas oxygen saturation on room air increased from 84 to 94% at 4 LÁmin-1 of oxygen and remained unchanged throughout the test. A 75-year-old woman with a history of ILD secondary to undifferentiated connective tissue disease and pulmonary hypertension presented with palpitation, breathlessness and recent impairment in left ventricular function (LVEF had decreased from 50 to 35% on echocardiography) She had diabetes and atrial fibrillation, which was managed with digoxin and warfarin. Case 3: Tc-99m tetrofosmin MPS of a 75-year-old woman with ILD and pulmonary hypertension showing mild septal flattening, a partially reversible apical anteroseptal defect and possible (minor) defect in the basal lateral wall. A 12-month clinical review was scheduled to re-assess the indication for LVRS
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