title: Safety of adenosine pharmacologic stress myocardial perfusion imaging in orthotopic cardiac transplant recipients: a single center experience of 102 transplant patients.
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.
authors.affiliation: Heart and Vascular Institute, Henry Ford Hospital, K 14, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
authors.forename: Mouaz H
authors.initials: MH
authors.lastname: Al-Mallah
authors.forename: Muhammad
authors.initials: M
authors.lastname: Arida
authors.forename: Enrique
authors.initials: E
authors.lastname: Garcia-Sayan
authors.forename: Chafik
authors.initials: C
authors.lastname: Assal
authors.forename: Gino Tapia
authors.initials: GT
authors.lastname: Zegarra
authors.forename: Barbara
authors.initials: B
authors.lastname: Czerska
authors.forename: Karthik
authors.initials: K
authors.lastname: Ananthasubramaniam
mesh_terms: D000241:Adenosine / Q000009:adverse effects; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000503:physiopathology; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D003326:Coronary Circulation; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000241:Adenosine