Randomized, Controlled Dose-Ranging Study of the Selective Adenosine A 2A Receptor Agonist Binodenoson for Pharmacological Stress as an Adjunct to Myocardial Perfusion Imaging

James E. Udelson, Gary V. Heller, Frans J.Th Wackers, Andrew Chai, David Hinchman, Patrick S. Coleman, Vasken Dilsizian, Marcello DiCarli, Rory Hachamovitch, James R. Johnson, Richard J. Barrett, Raymond J. Gibbons

Research output: Contribution to journalArticle

66 Scopus citations

Abstract

Background-Dipyridamole and adenosine cause frequent side effects as a result of nonspecific adenosine receptor stimulation. Selective agonism of the adenosine A2A receptor should result in a similar degree of coronary vasodilation (and thus similar perfusion images) with fewer side effects. Methods and Results-In a multicenter, randomized, single-blind, 2-arm crossover trial, 240 patients underwent 2 single photon emission computed tomographic (SPECT) imaging studies in random order, first after pharmacological stress with adenosine and a second study with the selective adenosine A2A receptor agonist binodenoson, using 1 of 4 dosing regimens. Safety, tolerability, and SPECT image concordance between the 2 agents were examined. Exact categorical agreement in the extent and severity of reversible perfusion defects ranged from 79% to 87%, with kappa values from 0.69 to 0.85, indicating very good to excellent agreement between binodenoson and adenosine. The risk of any safety event/side effect was significantly lower with any dose of binodenoson than with adenosine (P≤0.01) because of a dose-related reduction in subjective side effects, as objective events were infrequent. There was a reduction in the severity of chest pain, dyspnea, and flushing in all binodenoson doses compared with adenosine (P<0.01), and the magnitude of severity reduction was dose-related. Conclusions-The selective adenosine A 2A receptor agonist binodenoson results in an extent and severity of reversible perfusion defects on SPECT imaging similar to nonselective adenosine receptor stimulation, accompanied by a dose-related reduction in the incidence and severity of side effects.

Original languageEnglish (US)
Pages (from-to)457-464
Number of pages8
JournalCirculation
Volume109
Issue number4
DOIs
StatePublished - Feb 3 2004

Keywords

  • Adenosine
  • Imaging
  • Nuclear medicine
  • Scintigraphy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Udelson, J. E., Heller, G. V., Wackers, F. J. T., Chai, A., Hinchman, D., Coleman, P. S., Dilsizian, V., DiCarli, M., Hachamovitch, R., Johnson, J. R., Barrett, R. J., & Gibbons, R. J. (2004). Randomized, Controlled Dose-Ranging Study of the Selective Adenosine A 2A Receptor Agonist Binodenoson for Pharmacological Stress as an Adjunct to Myocardial Perfusion Imaging. Circulation, 109(4), 457-464. https://doi.org/10.1161/01.CIR.0000114523.03312.7D