Safety of adenosine pharmacologic stress myocardial perfusion imaging in orthotopic cardiac transplant recipients: A single center experience of 102 transplant patients

Mouaz H. Al-Mallah, Muhammad Arida, Enrique Garcia-Sayan, Chafik Assal, Gino Tapia Zegarra, Barbara Czerska, Karthik Ananthasubramaniam

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Denervation super-sensitivity to adenosine is well described in cardiac transplant (CT) patients particularly early after transplant. The safety and hemodynamic effects of adenosine SPECT (A-SPECT) has not been described in a large series of CT patients. Single center retrospective study of 102 CT patients undergoing A-SPECT were compared to an age-gender matched patients in a 2:1 fashion who underwent A-SPECT in the same time period. Multivariate logistic regression model were used to identify independent predictors of advanced AV block. The average time from CT to A-SPECT was 8.5 ± 4.5 years. Average age was 57 years with 80% males. In comparison to the control group, adenosine infusion was associated with a higher incidence of sinus pause (4.9% vs. 0%), 2nd (11.8% vs. 4.9%) and 3rd degree AVB (2.9% vs. 0%) in CT patients (all P < 0.05). Prior use of aspirin and baseline 1st degree AVB were significant independent predictors of adenosine induced AVB. Baseline right or left bundle branch block, beta-blockers, calcium blockers or digoxin were not associated with occurrence of AVB. Only 1.9% of A-SPECT studies were terminated due to bradyarrythmia with 1 patient requiring aminophylline. There were no significant immediate or long term adverse events in these patients. Adenosine pharmacologic stress is associated with a higher incidence of AVB and sinus pause in CT patients reflecting persistence of super sensitivity late after CT. Nevertheless these bradyarrythmias are transient without any sequelae suggesting that A-SPECT can be performed safely in CT patients.

Original languageEnglish (US)
Pages (from-to)1105-1111
Number of pages7
JournalInternational Journal of Cardiovascular Imaging
Volume27
Issue number7
DOIs
StatePublished - Oct 2011

Keywords

  • Adenosine
  • Atrioventricular block
  • Cardiac transplantation
  • Denervation supersensitivity
  • Single photon emission computed tomography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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