Role of the clinical radiopharmacist in patient safety during myocardial perfusion imaging with vasodilator stress agents

AIM

To assess the radiopharmacist's role in a multidisciplinary team focused on the contraindications of regadenoson in order to ensure the safe use of pharmacologic vasodilator stress agents in patients undergoing SPECT-MPI.

METHODS

We ambispectively studied its safe use in 1905 patients (54.1% female, mean age: 66.6±11.7 years, range: 20-95 years). Sex, age, medical history, medications, drug allergies, and contraindications for stress testing were registered together with recommendations for the nuclear physician in charge.

RESULTS

Detected contraindications and corresponding recommendations were as follows: risk factors for QTc interval prolongation 7.5% - measurement of QTc interval previously to test and monitor ECG; prior stroke or TIA 4.2% - consider carotid stenosis assessment; salicylates/sulfonamides allergy 3.1% - use 99mTc-sestamibi; epilepsy or risk factors for seizures 2.4% - use of adenosine or reconsider test indication; systemic corticosteroid therapy for severe COPD 1.3% - reassessment of patient's condition; acute exacerbation of COPD 0.8% - defer test until acute episode is over; severe asthma 0.4% - do not perform test; methylxanthine ingestion 0.3% - avoid consumption previously; other 6.1% - evaluation of other contraindications. No contraindications were detected in 73.6% of patients. The test was canceled due to absolute contraindications in 2.9% of the requests.

CONCLUSIONS

Working in a systematic way, the radiopharmacist was able to detect a high number of issues related to regadenoson, with one out of four patients presenting some clinical contraindication. The recommendations given by the radiopharmacist were well accepted by the nuclear physicians who changed their approach contributing to increase the safety of patients referred for MPI.

Role of the radiopharmacist in myocardial perfusion imaging safety as part of a multidisciplinary team

Funding Acknowledgements

Type of funding sources: None.

Background

Vasodilator stress agents have limitations and clinical contraindications that must be identified before patients undergo myocardial perfusion imaging (MPI). Clinical pharmacy may be viewed as part of radiopharmacy practice enabling radiopharmacists to recognize patients with an increased risk of complications and identify relative and absolute contraindications for vasodilator cardiac stress.

Purpose

Assessment of the role of the radiopharmacist in a multidisciplinary team focused on the safe performance of regadenoson and adenosine stress MPI.

Methods

We studied 800 patients undergoing SPECT MPI (55.9% female, mean age 67.1 ±11.4 y, range: 24-90 y).

Gender, age, medical history, medications, drug allergies and contraindications for stress testing were registered and the resulting recommendations were reported to the nuclear physician in charge of the patient.

Results

The table displays the findings and recommendations to the nuclear physician. No contraindications were found in 77.2% of patients.

Conclusion

With a systematic approach, the radiopharmacist detected a drug interaction or clinical contraindication in approximately 25% of patients and the reported recommendations were well received and accepted by the nuclear physicians who changed their approach with the resulting increased patient safety. The clinical activity of radiopharmacists can be enhanced and many opportunities will be identified. Physicians and nurses should be aware of the potential role of radiopharmacists as clinical providers in Nuclear Medicine departments.

Safety of regadenoson in patients with severe chronic obstructive pulmonary disease

OBJECTIVE

To assess the safety of regadenoson, a selective agonist of A2A adenosine receptors, combined with low-level exercise in subjects with severe chronic obstructive pulmonary disease (COPD), referred for myocardial perfusion imaging (MPI).

METHODS

We studied prospectively 12 male patients with severe COPD. Stress was 4min of low-level exercise with bolus injection of regadenoson (0.4mg) at 1.5min, followed by (99m)Tc-MPI agent injection. Demographics, medical history, lung medications, adverse events, oxygen saturation (SatO2), MPI findings for coronary artery disease (CAD), and changes in systolic blood pressure (SBP), and heart rate (HR) were registered.

RESULTS

The observed adverse event profile of regadenoson was similar to that of patients with mild-moderate COPD. There was no clinical exacerbation of COPD. Adverse events were self-limiting: dyspnea (33.3%), fatigue (25.0%), chest pain, headache (16.7%, respectively), and gastrointestinal discomfort, dry mouth, flushing, feeling hot and dizziness (8.3%, respectively). 25.0% of patients did not report any symptoms. We observed significant increases in SBP and HR from baseline (142.6mmHg±22.3 vs 152.5mmHg±18.5, and 80 b.p.m.±18 vs 105 b.p.m.±22, respectively; p<0.05).

CONCLUSIONS

Regadenoson combined with low-level exercise is safe and well tolerated in stable patients with severe COPD undergoing MPI.