Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Cardiovascular Magnetic Resonance
Published in: Journal of Cardiovascular Magnetic Resonance 1/2018

Open Access 01-12-2018 | Review

Aminophylline shortage and current recommendations for reversal of vasodilator stress: an ASNC information statement endorsed by SCMR

Authors: Aiden Abidov, Vasken Dilsizian, Rami Doukky, W. Lane Duvall, Christopher Dyke, Michael D. Elliott, Fadi G. Hage, Milena J. Henzlova, Nils P. Johnson, Ronald G. Schwartz, Gregory S. Thomas, Andrew J. Einstein

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2018

Login to get access

Abstract

Pharmacologic reversal of serious or intolerable side effects (SISE) from vasodilator stress is an important safety and comfort measure for patients experiencing such effects. While typically performed using intravenous aminophylline, recurrent shortages of this agent have led to a greater need to limit its use and consider alternative agents. This information statement provides background and recommendations addressing indications for vasodilator reversal, timing of a reversal agent, incidence of observed SISE with vasodilator stress, clinical and logistical considerations for aminophylline-based reversal, and alternative non-aminophylline based reversal protocols.
Literature
1.
Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: stress, protocols, and tracers. J Nucl Cardiol. 2016;23:606–39.CrossRef
2.
Daya HA, Hage FG. Effect of aminophylline administration on the diagnostic yield of vasodilator myocardial perfusion imaging. J Nucl Cardiol. 2017;24:1579–82.CrossRef
3.
Dilsizian V, Gewirtz H, Paivanas N, et al. Serious and potentially life threatening complications of cardiac stress testing: physiological mechanisms and management strategies. J Nucl Cardiol. 2015;22:1198–213.CrossRef
4.
Rai M, Ahlberg AW, Marwell J, Chaudhary W, Savino JA III, Alter EL, et al. Safety of vasodilator stress myocardial perfusion imaging in patients with elevated cardiac biomarkers. J Nucl Cardiol. 2017;24:724–34.CrossRef
5.
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.CrossRef
6.
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.CrossRef
7.
Sinusas AJ, Shi Q, Saltzberg MT, Vitols P, Jain D, Wackers FJ, et al. Technetium-99m-tetrofosmin to assess myocardial blood flow: experimental validation in an intact canine model of ischemia. J Nucl Med. 1994;35:664–71.PubMed
8.
Mousa SA, Cooney JM, Williams SJ. Relationship between regional myocardial blood flow and the distribution of 99mTc-sestamibi in the presence of total coronary artery occlusion. Am Heart J. 1990;119:842–7.CrossRef
9.
Glover DK, Ruiz M, Yang JY, Smith WH, Watson DD, Beller GA. Myocardial 99mTc-tetrofosmin uptake during adenosine-induced vasodilatation with either a critical or mild coronary stenosis: comparison with 201Tl and regional myocardial blood flow. Circulation. 1997;96:2332–8.CrossRef
10.
Watson DD, Glover DK. Overview of tracer kinetics and cellular mechanisms of uptake. In: Zaret BL, Beller GA, editors. Clinical nuclear cardiology. 4th ed. New York: Elsevier; 2010. p. 3–13.CrossRef
11.
Gui L, Duan W, Tian H, et al. Adenosine A2A receptor deficiency reduces striatal glutamate outflow and attenuates brain injury induced by transient focal cerebral ischemia in mice. Brain Res. 2009;1297:185–93.CrossRef
12.
Jolly AF, Thomas GS. Intravenous caffeine: an alternative to aminophylline to reverse adverse effects during regadenoson myocardial perfusion imaging. J Nucl Cardiol. 2017;24:1071–4.CrossRef
13.
Doukky R, Rangel MO, Dick R, Wassouf M, Alqaid A, Margeta B. Attenuation of the side effect profile of regadenoson: a randomized double-blind placebo-controlled study with aminophylline in patients undergoing myocardial perfusion imaging and have severe chronic kidney disease—the ASSUAGE-CKD trial. Int J Cardiovasc Imaging. 2013;29:1029–37.CrossRef
14.
Doukky R, Morales Demori R, Jain S, Kiriakos R, Mwansa V, Calvin JE. Attenuation of the side effect profile of regadenoson: a randomized double-blinded placebo-controlled study with aminophylline in patients undergoing myocardial perfusion imaging. “The ASSUAGE trial”. J Nucl Cardiol. 2012;19:448–57.CrossRef
15.
Fughhi I, Campagnoli T, Ali A, Doukky R. Impact of a regimented aminophylline administration protocol on the burden of regadenoson-induced ischemia detected by SPECT myocardial perfusion imaging. J Nucl Cardiol. 2017;24:1571–8.CrossRef
16.
Johnson NP, Lance Gould K. Dipyridamole reversal using theophylline during aminophylline shortage. J Nucl Cardiol. 2011;18:1115.CrossRef
17.
Doran JA, Sajjad W, Schneider MD, Gupta R, Mackin ML, Schwartz RG. Aminophylline and caffeine for reversal of adverse symptoms associated with regadenoson SPECT MPI. J Nucl Cardiol. 2017;24:1062–70.CrossRef
18.
Matangi M, Dutchak P. Buccal caffeine for the routine reversal of Persantine. J Nucl Cardiol. 2014;21:1039.CrossRef
19.
Subbiah R, Patil PV. Arrhythmias in vasodilator stress testing. J Nucl Cardiol. 2017;24:410–2.CrossRef
20.
Metadata
Title
Aminophylline shortage and current recommendations for reversal of vasodilator stress: an ASNC information statement endorsed by SCMR
Authors
Aiden Abidov
Vasken Dilsizian
Rami Doukky
W. Lane Duvall
Christopher Dyke
Michael D. Elliott
Fadi G. Hage
Milena J. Henzlova
Nils P. Johnson
Ronald G. Schwartz
Gregory S. Thomas
Andrew J. Einstein
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2018
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/s12968-018-0510-7

Other articles of this Issue 1/2018

Journal of Cardiovascular Magnetic Resonance 1/2018 Go to the issue

Research

Determination of aortic stiffness using 4D flow cardiovascular magnetic resonance - a population-based study

Research

Associations and prognostic significance of diffuse myocardial fibrosis by cardiovascular magnetic resonance in heart failure with preserved ejection fraction

Research

Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance

Research

Cardiovascular magnetic resonance black-blood thrombus imaging for the diagnosis of acute deep vein thrombosis at 1.5 Tesla

Research

Diabetes mellitus and insulin resistance associate with left ventricular shape and torsion by cardiovascular magnetic resonance imaging in asymptomatic individuals from the multi-ethnic study of atherosclerosis

Research

Systemic arteriosclerosis is associated with left ventricular remodeling but not atherosclerosis: a TASCFORCE study