Comparison of Dobutamine and Regadenoson Stress Cardiac Magnetic Resonance (MR)

Study Description

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Brief Summary:

The goal of this research is to determine the utility of Regadenoson (Lexiscan)for use as an imaging agent with cardiac MR. If found useful, it will help us establish a protocol for regadenoson stress MR perfusion (Regadenoson stress test with cardiac MR).The investigators will compare regadenoson with dobutamine so each participant will undergo two studies. A cardiac MR stress test with regadenoson and with dobutamine. The investigators participants will include patients with history of COPD and Asthma, so it will also help us determine feasibility of Regadenoson in these patient's subgroups.

Condition or disease	Intervention/treatment	Phase
Coronary Artery Disease; Asthma; Chronic Obstructive Pulmonary Disease (COPD); Angina	Drug: Regadenoson, Dobutamine	Phase 4

Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	40 participants
Allocation:	Randomized
Intervention Model:	Crossover Assignment
Masking:	Single (Outcomes Assessor)
Primary Purpose:	Diagnostic
Official Title:	Comparison of Dobutamine and Regadenoson Stress CMR
Study Start Date :	January 2009
Actual Primary Completion Date :	December 2010
Actual Study Completion Date :	March 2011

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Active Comparator: A; Arm A will get Dobutamine Stress test with cardiac MR (CMR). Both arms will then cross over to the other arm to get the second test. So each participant will undergo two types of testing.	Drug: Regadenoson, Dobutamine; Cross-over design in which each participant will receive regadenoson 0.4mg (5ml) one time bolus dose at one visit and dobutamine infusion (as per protocol to achieve a target heart rate of 85% of predicted for age) at another visit.; Other Name: Lexiscan
Active Comparator: B; Arm B will get Regadenoson stress test with CMR. Both arms will then cross over to the other arm to get the second test. So each participant will undergo two types of testing.	Drug: Regadenoson, Dobutamine; Cross-over design in which each participant will receive regadenoson 0.4mg (5ml) one time bolus dose at one visit and dobutamine infusion (as per protocol to achieve a target heart rate of 85% of predicted for age) at another visit.; Other Name: Lexiscan

Outcome Measures

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Primary Outcome Measures :

1. Duration of procedures [ Time Frame: 1 day ]
   To compare the time involved during pharmacologic stress testing using regadenoson versus intravenous dobutamine in individuals with moderate to severe chronic obstructive pulmonary disease (COPD)or asthma.

Secondary Outcome Measures :

1. Ease of Administration of regadenoson versus intravenous dobutamine. [ Time Frame: 1 day ]
   To compare the ease of administration of regadenoson verses intravenous dobutamine during pharmacologic stress testin in individuals with moderate to severe chronic obstructive pulmonary disease (COPD) or asthma.

Eligibility Criteria

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Ages Eligible for Study:	40 Years to 85 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

• Men and women aged 40 to 85 years with OBSTRUCTIVE AIRWAY DISEASES (ASTHMA AND COPD) and a forced expiratory volume (FEV1) > 0.5.
• Patients should have a clinical indication to undergo cardiac stress test with dobutamine.

Exclusion Criteria:

• Those with pacemakers, defibrillators, functioning neural stimulator devices or other implanted electronic devices.
• Ferromagnetic cerebral aneurism clips or other intraorbital and intracranial metal.
• An allergy to Gadolinium or other severe drug allergies.
• Acute myocardial infarction within 3 months.
• Moderate or severe aortic stenosis or other significant valvular disease;
• Claustrophobia.
• High grade (2o or 3o) AV Block.
• Closed angle glaucoma.
• Participants unable to provide informed consent.
• Renal dialysis (subjects with moderate-to-severe renal impairment defined as eGFR < 60 mL/min.
• A contraindication to receipt of dobutamine.
• Participants with known coronary artery disease will be included with the exception that patients with left main or narrowings >50% in the distributions of the left anterior descending, circumflex, and right coronary artery will be excluded.

Contacts and Locations

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Locations

United States, North Carolina
WAKE FOREST UNIVERSITY Baptist Medical Center
Winston Salem, North Carolina, United States, 27157

Sponsors and Collaborators

Wake Forest University Health Sciences

Astellas Pharma US, Inc.

Investigators

Principal Investigator:	William G Hundley, M.D., F.A.C.C., F.A.H.A	Wake Forest University Health Sciences

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Publications:

Leaker BR, O'Connor B, Hansel TT, Barnes PJ, Meng L, Mathur VS, Lieu HD. Safety of regadenoson, an adenosine A2A receptor agonist for myocardial perfusion imaging, in mild asthma and moderate asthma patients: a randomized, double-blind, placebo-controlled trial. J Nucl Cardiol. 2008 May-Jun;15(3):329-36. doi: 10.1016/j.nuclcard.2008.02.009. Epub 2008 Apr 14.

Thomas GS, Tammelin BR, Schiffman GL, Marquez R, Rice DL, Milikien D, Mathur V. Safety of regadenoson, a selective adenosine A2A agonist, in patients with chronic obstructive pulmonary disease: A randomized, double-blind, placebo-controlled trial (RegCOPD trial). J Nucl Cardiol. 2008 May-Jun;15(3):319-28. doi: 10.1016/j.nuclcard.2008.02.013. Epub 2008 Apr 14.

Iskandrian AE, Bateman TM, Belardinelli L, Blackburn B, Cerqueira MD, Hendel RC, Lieu H, Mahmarian JJ, Olmsted A, Underwood SR, Vitola J, Wang W; ADVANCE MPI Investigators. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol. 2007 Sep-Oct;14(5):645-58.

Gordi T, Frohna P, Sun HL, Wolff A, Belardinelli L, Lieu H. A population pharmacokinetic/pharmacodynamic analysis of regadenoson, an adenosine A2A-receptor agonist, in healthy male volunteers. Clin Pharmacokinet. 2006;45(12):1201-12.

Hendel RC, Bateman TM, Cerqueira MD, Iskandrian AE, Leppo JA, Blackburn B, Mahmarian JJ. Initial clinical experience with regadenoson, a novel selective A2A agonist for pharmacologic stress single-photon emission computed tomography myocardial perfusion imaging. J Am Coll Cardiol. 2005 Dec 6;46(11):2069-75. Epub 2005 Nov 9.

Responsible Party:	WILLIAM GREGORY HUNDLEY MD, Wake Forest University Baptist Medical Center
ClinicalTrials.gov Identifier:	NCT00763035 History of Changes
Other Study ID Numbers:	Hundley-2
First Posted:	September 30, 2008
Last Update Posted:	July 29, 2011
Last Verified:	April 2010

Keywords provided by Wake Forest University Health Sciences:

Coronary Artery Disease; Coronary Vessels; Myocardial Ischemia; Coronary Disease	Ischemic heart disease; asthma; copd

Additional relevant MeSH terms:

Lung Diseases; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Diseases; Heart Diseases; Cardiovascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases; Dobutamine; Regadenoson; Cardiotonic Agents

Sympathomimetics; Autonomic Agents; Peripheral Nervous System Agents; Physiological Effects of Drugs; Adrenergic beta-1 Receptor Agonists; Adrenergic beta-Agonists; Adrenergic Agonists; Adrenergic Agents; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Protective Agents; Adenosine A2 Receptor Agonists; Purinergic P1 Receptor Agonists; Purinergic Agonists; Purinergic Agents