Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Safety of regadenoson stress testing in patients with pulmonary hypertension Victor M. Moles, MD (a); Thomas Cascino, MD (a); Ashraf Saleh, MD (c); Krasimira Mikhova, MD (c); John J. Lazarus, MD (a); Michael Ghannam, MD (a); Hong J. Yun, MD (a); Matthew Konerman, MD (a); Richard L. Weinberg, MD, PhD (a); Edward P. Ficaro, PhD (b); James R. Corbett, MD (a,b); Vallerie V. McLaughlin, MD (a); Venkatesh L. Murthy, MD, PhD (a,b) a) Division of Cardiovascular Medicine (Department of Internal Medicine) and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI b) Division of Nuclear Medicine (Department of Radiology), University of Michigan, Ann Arbor, MI c) Department of Internal Medicine, University of Michigan, MI Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology BACKGROUND 1- Pulmonary hypertension (PH) is increasingly recognized at more advanced ages. 2- As many as one third of patients with PH may have coronary artery disease. 3- Regadenoson can potentially have an adverse impact due to their tenuous hemodynamics. 4- The effect of regadenoson in patients with pulmonary hypertension remains unknown. Copyright American Society of Nuclear Cardiology

METHODS Study type: Study subjects: Study goals: Study variables: Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology METHODS Study type: Retrospective observational study. Study subjects: Patients with diagnosed pulmonary hypertension by a right heart catheterization (mean PA pressure > 25 mmHg) not solely due to left heart disease. Study goals: We sought to determine the safety of regadenoson stress testing in patients with PH. Study variables: Hemodynamic response (heart rate and blood pressure). Electrocardiographic response (ischemia, AV blocks, arrhythmias). Immediate side effects. Side effects related to regadenoson within 30 days of study. Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Hemodynamic response to regadenoson.   Pre infusion Post infusion p HR, overall (bpm) HR, with exercise (n = 10) HR, without exercise (n = 57) 74.6 ± 14 78.3 ± 15.7 73.9 ± 13.7 96.3 ± 18.3 114.6 ± 19.7 93.1 ± 16.2 < 0.001 0.005 < 0.001 SBP, overall (mmHg) SBP, with exercise (n = 10) SBP, without exercise (n=57) 129.8 ± 20.9 129.2 ± 23 129.9 ± 20.7 131.8 ± 31 143.2 ± 43.7 129.8 ± 28.2 0.67 044 0.97 DBP, overall (mmHg) DBP, with exercise (n = 10) DBP, without exercise (n = 57) 77.1 ± 11.4 75.6 ± 12.3 77.3 ± 11.3 72.9 ± 15.3 76.8 ± 22.1 72.3 ± 13.9 0.02 0.007 Side effects after administration of regadenoson. Symptoms Overall (N = 67) N (%) With Exercise (N = 10) Without Exercise (N = 57) p Chest pain 36 (53.7%) 0 (0%) 5 (8.8%) 0.43 Dyspnea 48 (70.6%) 7 (70%) 41 (71.9%) 0.58 Nausea 6 (8.8%) 6 (10.5%) 0.36 Headache 3 (4.4%) 3 (5.3%) 0.61 Dizziness Fatigue 2 (2.9%) 2 (20%) 0.02 Flushing Syncope 1 Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS ECG changes after administration of regadenoson. Response Overall (N = 67) N (%) With Exercise (N = 10) N(%) Without Exercise (N = 57) p Normal ST response 53 (77.9%) 6 (60%) 47 (82.5%) 0.12 ST depression 0.5 – 0.9 mm 4 (5.9%) 2 (20%) 2 (3.5%) 0.1 ST depression 1 – 1.9 mm 3 (4.4%) 1 (1.8%) 0.05 ST depression > 2 mm 0 (0%) 1 Non diagnostic due to baseline 7 (10.3%) 7 (12.3%) 0.3 ST elevation PAC 1 (10%) 6 (10.5%) 0.72 PVC 27 (39.7%) 5 (50%) 22 (38.6%) 0.36 SVT 2 (2.9%) 0.71 VT VF 1st degree AV block 2nd degree AV block 3rd degree AV block Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology CONCLUSIONS 1- To our knowledge, this is the first study assessing the safety of regadenoson stress testing in patients with PH. 2- Regadenoson stress testing with routine administration of aminophylline in patients with PH is safe and represents an alternative to coronary angiography for the diagnosis of coronary artery disease. Copyright American Society of Nuclear Cardiology