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AlJaroudi W, Anokwute C, Fughhi I, Campagnoli T, Wassouf M, Vij A, Kharouta M, Appis A, Ali A, Doukky R. The prognostic value of heart rate response during vasodilator stress myocardial perfusion imaging in patients with end-stage renal disease undergoing renal transplantation. J Nucl Cardiol 2019; 26:814-822. [PMID: 28924814 DOI: 10.1007/s12350-017-1061-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 08/31/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND In asymptomatic end-stage renal disease (ESRD) patients undergoing vasodilator stress myocardial perfusion imaging (MPI) prior to renal transplantation (RT), the impact of pre-transplant heart rate response (HRR) to vasodilator stress on post-RT outcomes is unknown. METHODS We analyzed a retrospective cohort of asymptomatic patients with ESRD who underwent a vasodilator stress SPECT-MPI and subsequently received RT. Blunted HRR was defined as HRR <28% for regadenoson stress and <20% for adenosine stress. The primary endpoint was major adverse cardiac events (MACE), defined as cardiac death or myocardial infarction. Clinical risk was assessed using the sum of risk factors set forth by the AHA/ACCF consensus statement on the assessment of RT candidates. RESULTS Among 352 subjects, 140 had an abnormal pre-transplant HRR. During a mean follow-up of 3.2 ± 2.0 years, 85 (24%) MACEs were observed. Blunted HRR was associated with increased MACE risk (hazard ratio 1.72; 95% confidence interval 1.12-2.63, P = 0.013), and remained significant after adjustment for gender, sum of AHA/ACCF risk factors, summed stress score, baseline heart rate, and β-blocker use. HRR was predictive of MACE in patients with normal MPI and irrespective of clinical risk. Blunted HRR was associated with a significant increase in post-operative (30-day) MACE risk (17.9% vs 8.5%; P = 0.009). CONCLUSION In asymptomatic ESRD patients being evaluated for RT, a blunted pre-transplant HRR was predictive of post-RT MACE. HRR may be a valuable tool in the risk assessment of RT candidates.
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Affiliation(s)
- Wael AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Chiedozie Anokwute
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Ibtihaj Fughhi
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Tania Campagnoli
- Division of Cardiology, Cook County Health and Hospitals System, 1901 W. Harrison St., Suite # 3620, Chicago, IL, 60612, USA
| | - Marwan Wassouf
- Department of Medicine, Fairview Hospital, Cleveland, OH, USA
| | - Aviral Vij
- Division of Cardiology, Cook County Health and Hospitals System, 1901 W. Harrison St., Suite # 3620, Chicago, IL, 60612, USA
| | - Michael Kharouta
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Andrew Appis
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Amjad Ali
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Rami Doukky
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
- Division of Cardiology, Cook County Health and Hospitals System, 1901 W. Harrison St., Suite # 3620, Chicago, IL, 60612, USA.
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA.
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Doukky R, Fughhi I, Campagnoli T, Wassouf M, Kharouta M, Vij A, Anokwute C, Appis A, Ali A. Validation of a clinical pathway to assess asymptomatic renal transplant candidates using myocardial perfusion imaging. J Nucl Cardiol 2018; 25:2058-2068. [PMID: 28484986 DOI: 10.1007/s12350-017-0901-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/06/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND An AHA/ACCF scientific statement proposed 8 risk factors to assess the need for noninvasive coronary artery disease (CAD) surveillance in asymptomatic patients undergoing evaluation for kidney transplantation. The clinical application of these risk factors and the role of noninvasive testing in this context have not been defined. METHODS AND RESULTS We retrospectively followed a cohort of 581 consecutive kidney transplant recipients of whom 401 had pre-transplant radionuclide myocardial perfusion imaging (MPI) and 90 had pre-transplant coronary angiography. The sum of pre-transplant AHA/ACCF risk factors (age >60 years, hypertension, diabetes, cardiovascular disease, dyslipidemia, smoking, dialysis >1 year, left ventricular hypertrophy) was calculated. MPI scans were analyzed by a "blinded" reader. Patients were followed for a mean of 3.7 ± 2.3 years post-transplant for major adverse cardiac events (MACE), defined as cardiac death or non-fatal myocardial infarction. The sum of risk factors was associated with modest discriminatory capacity for obstructive angiographic CAD (area under the curve [AUC], 0.70; P = 0.004), 30-day post-operative MACE (AUC, 0.60; P = 0.036), and long-term MACE (AUC, 0.63; P < 0.001). A threshold of ≥3 risk factors was optimal for identifying patients at risk. MPI provided incremental predictive value for obstructive CAD (P = 0.02) and long-term MACE (P = 0.04) but not post-operative MACE (P = 0.56). MPI was best predictive of long-term MACE in intermediate risk (3-4 risk factors) patients. CONCLUSIONS Asymptomatic kidney transplant candidates with ≥3 AHA/ACCF risk factors are at increased cardiac risk, and should be considered for noninvasive CAD surveillance. Intermediate risk patients (3-4 factors) benefit the most from pre-transplant MPI to define long-term MACE risk.
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Affiliation(s)
- Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA.
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA.
- Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison Street, Chicago, IL, 60612, USA.
| | - Ibtihaj Fughhi
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Tania Campagnoli
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Marwan Wassouf
- Department of Medicine, Fairview Hospital, Cleveland, OH, USA
| | - Michael Kharouta
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Aviral Vij
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA
| | - Chiedozie Anokwute
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Andrew Appis
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Amjad Ali
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
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Anokwute C, Fughhi I, Wassouf M, Kharouta M, Campagnoli T, Vij A, Khoudary G, Khan R, Teshome M, Appis A, Doukky R. THE PROGNOSTIC VALUE OF SERIAL STRESS MYOCARDIAL PERFUSION IMAGING IN ASYMPTOMATIC END-STAGE RENAL DISEASE PATIENTS AWAITING KIDNEY TRANSPLANTATION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34871-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Doukky R, Fughhi I, Campagnoli T, Wassouf M, Ali A. The prognostic value of regadenoson SPECT myocardial perfusion imaging in patients with end-stage renal disease. J Nucl Cardiol 2017; 24:112-118. [PMID: 26582040 DOI: 10.1007/s12350-015-0303-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 10/01/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prognostic value of regadenoson SPECT myocardial perfusion imaging (MPI) has not been specifically studied in patients with end-stage renal disease (ESRD). METHODS AND RESULTS We prospectively followed ESRD patients enrolled in the ASSUAGE and ASSUAGE-CKD trials in which they received regadenoson-stress 99mTc-tetrofosmin SPECT-MPI. Images were semiquantitatively analyzed by an investigator blinded to clinical and outcome data. Patients were followed for cardiac death, myocardial infarction (MI), and coronary revascularization (CR). Revascularizations occurring >90 days post-MPI were considered "late" events. Survival analysis was performed using Cox regression models, adjusting for age, gender, diabetes, dyslipidemia, smoking, and known coronary artery disease. We analyzed 303 patients (mean age 54 years; 64% men), who were followed for 35 ± 10 months. Adjusting for clinical covariates, abnormal regadenoson-stress MPI (SSS ≥ 4) was associated with increased risk of the composite of cardiac death or MI (23.9% vs 14.4%; HR 1.88; CI 1.04-3.41; P = .037) and the composite of cardiac death, MI, or late CR (27.3% vs 16.7%; HR 1.80; CI 1.03-3.14; P = .039). Adjusting for clinical covariates, regadenoson-induced myocardial ischemia (SDS ≥ 2) was associated with increased rate of the composite endpoint of cardiac death, MI, or CR (33.3% vs 16.9%; HR 1.97; CI 1.19-3.27; P = .008). CONCLUSION Regadenoson-stress SPECT-MPI provides a significant prognostic value in patients with ESRD. ESRD patients with normal SPECT-MPI have relatively high adverse event rates.
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Affiliation(s)
- Rami Doukky
- Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St., Suite # 3620, Chicago, IL, 60612, USA.
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
| | - Ibtihaj Fughhi
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Tania Campagnoli
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Marwan Wassouf
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Amjad Ali
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
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AlJaroudi W, Campagnoli T, Fughhi I, Wassouf M, Ali A, Doukky R. Prognostic value of heart rate response during regadenoson stress myocardial perfusion imaging in patients with end stage renal disease. J Nucl Cardiol 2016; 23:560-9. [PMID: 26293358 DOI: 10.1007/s12350-015-0234-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 06/29/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Blunted heart rate response (HRR) to vasodilator stress agents is associated with worse outcomes. There are limited data assessing the effect of impaired HRR to regadenoson among patients with end-stage renal disease (ESRD) undergoing stress myocardial perfusion imaging (MPI). METHODS We prospectively followed patients with ESRD enrolled in the ASSUAGE and ASSUAGE-CKD trials. HRR was defined as 100*(peak stress heart rate-resting heart rate)/resting heart rate. Study cohort was dichotomized to blunted and normal HRR groups according to an established median HRR value <28% or ≥28%, which were propensity-score matched based on 22 clinical and imaging covariates. The Primary endpoint was all-cause death. The secondary cardiac-specific endpoints included: (1) the composite endpoint of cardiac death or myocardial infarction; (2) the composite endpoint of cardiac death, myocardial infarction, or late (>90 days) coronary revascularization. RESULTS There were 303 patients followed for 35 ± 10 months. In the entire cohort, there was a stepwise increase in the rates of death and all secondary endpoints with worsening HRR (P values ≤.001). Blunted HRR (<28%) was associated with increased risk of death (unadjusted hazard ratio 4.10 [1.98-8.46], P < .001) and all secondary endpoints (P ≤ .001). After multivariate adjustment, HRR remained an independent predictor of mortality and secondary endpoints whether used as continuous or dichotomous variable, and added incremental prognostic value for all-cause death (P = .046). Blunted HRR was associated with increased event rate among patients with normal myocardial perfusion (P = .001) and abnormal perfusion (P = .053). In the propensity-matched cohort of 132 patients (66 in each group), blunted HRR was associated with significant increase in all-cause death (21% vs. 5%, HR 5.09 [1.46-17.7], P=.011), and similarly for the secondary endpoints. CONCLUSION Blunted HRR (<28%) to regadenoson is a strong and independent predictor of death and cardiovascular events in patients with ESRD and adds incremental prognostic value.
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Affiliation(s)
- Wael AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Tania Campagnoli
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Ibtihaj Fughhi
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Marwan Wassouf
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Amjad Ali
- Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Rami Doukky
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
- Division of Cardiology, John H. Stroger Jr. Hospital of Cook County, 1901 W. Harrison St., Suite # 3620, 60612, Chicago, IL, USA.
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Patel M, Wassouf M, Garcia-Sayan E, Pant R, Heidari GB, Shah S, D’Silva O, Kehoe R, Doukky R. DERIVATION AND VALIDATION OF A SIMPLE DIASTOLIC FUNCTION PARAMETER FOR THE PREDICTION OF LEFT ATRIAL APPENDAGE THROMBUS IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vij A, Fughhi I, Campagnoli T, Onuegbu A, Anokwute C, Teshome M, Kharouta M, Rojas E, Khoudary G, Hatahet M, Wassouf M, Appis A, Doukky R, Stroger JH. THE DIAGNOSTIC UTILITY OF RISK FACTORS DEFINED BY THE AHA/ACCF EXPERT CONSENSUS STATEMENT ON THE EVALUATION OF CARDIAC DISEASE IN RENAL TRANSPLANT RECIPIENTS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Doukky R, Garcia-Sayan E, Patel M, Pant R, Wassouf M, Shah S, D'Silva O, Kehoe RF. Impact of Diastolic Function Parameters on the Risk for Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation: A Prospective Study. J Am Soc Echocardiogr 2016; 29:545-53. [PMID: 27021354 DOI: 10.1016/j.echo.2016.01.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with nonvalvular atrial fibrillation (NVAF), the impact of left ventricular diastolic function on the risk for left atrial appendage (LAA) thrombus has not been prospectively studied. METHODS At two academic medical centers, patients with NVAF were prospectively enrolled to undergo investigational transthoracic echocardiography immediately before clinically indicated transesophageal echocardiography. Mitral inflow E velocity and tissue Doppler septal and lateral mitral annulus velocities (e') were measured, and E/e' ratios were calculated. RESULTS Among 266 subjects (mean age, 65 years; 32% women), 17 (6.4%) had LAA thrombus. Patients with LAA thrombus had a higher mean CHA2DS2-VASc score (4.6 ± 1.7 vs 3.0 ± 1.8, P < .001), a higher mean lateral E/e' ratio (19.4 ± 10.1 vs 10.2 ± 5.6, P < .001), and a lower mean lateral e' velocity (7.0 ± 3.2 vs 10.4 ± 3.7 cm/sec, P = .001). There was a good discriminative capacity for E/e' (area under the curve, 0.83; P < .001) and e' velocity (area under the curve, 0.76; P = .001). None of the patients with normal E/e' ratios or normal e' velocities had LAA thrombus. Both E/e' (odds ratio, 1.13 per point; 95% CI, 1.06-1.20; P < .001) and e' velocity (odds ratio, 0.76 per 1 cm/sec; 95% CI, 0.63-0.92; P = .005) provided independent and incremental predictive value beyond the CHA2DS2-VASc score; however, E/e' provided greater incremental value than e' velocity (P = .036). Analyses using septal and averaged E/e' and septal e' velocity yielded similar results. Diastolic function parameters were also associated with the presence and intensity of left atrial spontaneous echo contrast, a precursor of LAA thrombus. CONCLUSIONS This prospective and concomitant evaluation of diastolic function and LAA thrombus in patients with NVAF demonstrates that E/e' ratio and e' velocity are associated with LAA thrombus, independent of CHA2DS2-VASc score, and may play a role in identifying patients at low risk for LAA thrombus. These data suggest that diastolic function assessment may improve stroke prediction in patients with NVAF.
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Affiliation(s)
- Rami Doukky
- Division of Adult Cardiology, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois; Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
| | - Enrique Garcia-Sayan
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois; Division of Cardiology, Mount Sinai Hospital, Chicago, Illinois
| | - Mita Patel
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois; Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rojina Pant
- Division of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | - Marwan Wassouf
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois; Department of Medicine, Fairview Hospital, Cleveland, Ohio
| | - Saurabh Shah
- Division of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | - Oliver D'Silva
- Division of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois
| | - Richard F Kehoe
- Division of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois
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Pant R, Patel M, Garcia-Sayan E, Wassouf M, D'Silva O, Kehoe RF, Doukky R. Impact of B-type natriuretic peptide level on the risk of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation: a prospective study. Cardiovasc Ultrasound 2016; 14:4. [PMID: 26772738 PMCID: PMC4715322 DOI: 10.1186/s12947-016-0047-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 01/12/2016] [Indexed: 01/20/2023] Open
Abstract
Background The impact of B-type natriuretic peptide (BNP) level on the risk of left atrial appendage (LAA) thrombus in patients with nonvalvular atrial fibrillation (NVAF) has not been prospectively studied. Methods In two academic medical centers, we obtained BNP levels immediately prior to transesophageal echocardiogram performed to exclude LAA thrombus in patients with NVAF. Results Among 261 subjects (mean age 65 ± 12 years; 30 % women) with NVAF, 17 (6.5 %) had LAA thrombus and 85 (32.6 %) had at least mild spontaneous echo contrast (SEC). Mean BNP level was significantly higher in patients with LAA thrombus [775 ± 678 vs. 384 ± 537, P = 0.001]. Receiver operator characteristics analysis demonstrated that BNP has a good discriminatory capacity for LAA thrombus (area under the curve, 0.74; 95 % confidence interval [CI], 0.63–0.85; P = 0.001); BNP ≥ 67 pg/mL was 100 % sensitive and 20 % specific for LAA thrombus. Multivariate logistic regression analysis demonstrated that BNP was not independently associated with LAA thrombus (odds-ratio, 1.05 per 100 pg/mL increment; CI, 0.99–1.12; P = 0.127) after adjusting for CHA2DS2-VASc score; while the latter was independently associated with LAA thrombus after adjusting for BNP level (odds-ratio, 1.46 per CHA2DS2-VASc point; CI, 1.09–1.96; P = 0.011). Nonetheless, BNP was associated with SEC in univariate and multivariate analysis, after adjusting for the CHA2DS2-VASc score, (odds-ratio, 1.08; CI, 1.02–1.14; P = 0.005). Conclusions BNP is predictive of SEC. However, it does not provide significant incremental value in the prediction of LAA thrombus.
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Affiliation(s)
- Rojina Pant
- Division of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Mita Patel
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.,Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Enrique Garcia-Sayan
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.,Division of Cardiology, Mount Sinai Hospital, Chicago, IL, USA
| | - Marwan Wassouf
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.,Department of Medicine, Fairview Hospital, Cleveland, OH, USA
| | - Oliver D'Silva
- Division of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Richard F Kehoe
- Division of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Rami Doukky
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA. .,Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St, Chicago, IL, 60612, USA.
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Rangel MO, Morales Demori R, Voll ST, Wassouf M, Dick R, Doukky R. Severe chronic kidney disease as a predictor of benefit from aminophylline administration in patients undergoing regadenoson stress myocardial perfusion imaging: A substudy of the ASSUAGE and ASSUAGE-CKD trials. J Nucl Cardiol 2015; 22:1008-18. [PMID: 25500799 DOI: 10.1007/s12350-014-0036-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/14/2014] [Accepted: 11/15/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Regadenoson is predominantly renally metabolized. Patients with severe chronic kidney disease (CKD) experience more frequent gastrointestinal adverse effects (AE) from regadenoson. Aminophylline use following regadenoson reduces the incidence of regadenoson-related AE. We investigated whether patients with severe CKD receive incremental benefit from aminophylline administration in reducing regadenoson AE. METHODS We performed post hoc analysis of the pooled database of the ASSUAGE and ASSUAGE-CKD trials. These were randomized placebo-controlled clinical trials which tested the benefit of intravenous aminophylline vs placebo after regadenoson injection in patients undergoing a clinically indicated stress MPI. Patients were categorized into two treatment arms: aminophylline vs placebo; and two groups: Severe CKD (GFR < 30 mL·min(-1)/1.73 m(2) or dialysis) and Control (GFR ≥ 30 mL·min(-1)/1.73 m(2)). The study endpoints were gastrointestinal AE, non-gastrointestinal AE and composite of any regadenoson AE. RESULT The pooled database of the two trials yielded 548 patients, of whom 274 patients received aminophylline and 274 received placebo. Aminophylline was associated with greater absolute risk reduction (ARR) in gastrointestinal AE among patients with severe CKD vs controls (25% vs 4%, p < .001). A significant interaction was identified between severe CKD and aminophylline in reducing gastrointestinal AE (p = .007), indicating greater reduction in gastrointestinal AE with aminophylline use among patients with severe CKD. Aminophylline use was associated with a trend toward greater ARR in any regadenoson-related AE (32% vs 21%, p = .08). CONCLUSION Aminophylline is associated with incremental benefit in reducing gastrointestinal AE in patients with severe CKD undergoing regadenoson stress MPI. Potentially, this population could be targeted for prophylactic administration of aminophylline in order to improve their overall experience with the test.
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Affiliation(s)
| | - Raysa Morales Demori
- Department of Pediatrics, University of Illinois Hospital and Health System, Chicago, IL, USA
| | - Sarah T Voll
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
- Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St., Chicago, IL, 60612, USA
| | - Marwan Wassouf
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Rizcallah Dick
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Rami Doukky
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
- Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St., Chicago, IL, 60612, USA.
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Doukky R, Rangel MO, Wassouf M, Dick R, Alqaid A, Morales Demori R. The safety and tolerability of regadenoson in patients with end-stage renal disease: the first prospective evaluation. J Nucl Cardiol 2013; 20:205-13. [PMID: 23239416 DOI: 10.1007/s12350-012-9654-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 11/03/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND There has not been any prospective evaluation of the safety and tolerability of regadenoson (REG)-stress in patients with end-stage renal disease (ESRD). METHODS From the pooled database of two identically designed randomized, double-blinded, placebo-controlled clinical trials, ASSUAGE and ASSUAGE-CKD (IV-aminophylline vs placebo following REG-stress), we extracted the placebo-treated subjects to form 2 study groups: ESRD (dialysis or GFR < 15 mL/minute/1.73 m(2)) and control (GFR ≥ 30). The incidence of REG adverse effects and the hemodynamic and ECG responses to REG-stress were compared. RESULTS We identified 146 ESRD subjects and 97 controls. There was no significant difference in the incidence of the composite of any REG adverse effect [ESRD 108 (74%) vs control 73 (75%), P = .82]. ESRD patients seem to have excess incidences of diarrhea [42 (29%) vs 14 (14%), P = .009] and fewer events of dizziness [28 (19%) vs 43 (44%), P < .001]. There were no serious adverse events in either group. There was no significant difference in the incidence of ST-segment deviation, tachyarrhythmias, atrioventricular block, or hypotension. CONCLUSION This is the first prospective study to confirm the safety and tolerability of REG in patients with ESRD.
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Affiliation(s)
- Rami Doukky
- Section of Cardiology, Rush University Medical Center, 1653 W. Congress Pkwy, Chicago, IL 60612, USA.
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Rangel MO, Wassouf M, Dick R, Morales-Demori RC, Pant R, Margeta B, Doukky R. THE SAFETY AND TOLERABILITY OF REGADENOSON IN PATIENTS WITH END-STAGE RENAL DISEASE: THE FIRST PROSPECTIVE EVALUATION. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61314-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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