search
Back to results

A Study of Regadenoson in Subjects Undergoing Stress Myocardial Perfusion Imaging (MPI) Using Multidetector Computed Tomography (MDCT) Compared to Single Photon Emission Computed Tomography (SPECT)

Primary Purpose

Coronary Artery Disease (CAD)

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
regadenoson
technetium Tc99m sestamibi /technetium Tc99m tetrafosmin
Contrast
Single Photon Emission Computed Tomography
Multidetector Computed Tomography
Sponsored by
Astellas Pharma Inc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Coronary Artery Disease (CAD) focused on measuring pharmacologic stress, Coronary Artery Disease (CAD), regadenoson, ischemia

Eligibility Criteria

45 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male subjects must be ≥ 45 years of age
  • Female subjects must be ≥ 50 years of age
  • Subject has met at least one of the following three criteria:

    • has a suspected (clinical impression) or known diagnosis of coronary artery disease (CAD) with typical angina that has been referred from nuclear cardiology lab schedule or cardiac computed tomography (CT) schedule
    • has stable symptoms with possible elective catheterization procedure scheduled and where further imaging may be beneficial;
    • has known CAD from a previous invasive coronary angiography (ICA) performed more than 12 weeks prior to screening who now present with new cardiac symptoms
  • Subject has been referred for a clinically indicated myocardial perfusion imaging procedure or Cardiac CT procedure for suspected moderate or high risk CAD
  • Subject must abstain from eating and drinking 30 minutes prior and 30 minutes post study drug administration
  • Subject must abstain from smoking 3 hours prior and 8 hours post study drug administration
  • Subject must abstain from any intake of methylxanthine-containing foods and beverages within 12 hours prior to Day 1 visit through the Day 3 Follow-Up Visit, as these foods may alter regadenoson effects. Subject is able to safely abstain from theophylline use for 12 hours prior to study drug administration

Exclusion Criteria:

  • Subject is concurrently participating in another drug study or has received an investigational drug within 30 days prior to Screening
  • Subject has a history of a clinically significant illness (other than CAD), medical condition, or laboratory abnormality, which would preclude participation in the study
  • Subject has renal dysfunction demonstrated by a glomerular filtration rate (GFR) < 45 mL/min (calculated using Cockroft-Gault formula Note: Subjects with a GFR 45-60 mL/min will undergo a hydration procedure
  • Female subject who is pregnant, lactating or of childbearing potential that refuses to use a medically acceptable form of contraception until the Telephone Follow up Visit is complete
  • Female subject has a positive pregnancy test prior to randomization
  • Subject has a history of second or third degree heart block or sinus node dysfunction unless the subject has a functioning pacemaker
  • Subject has symptomatic hypotension (temporary and reversible conditions that no longer exist are allowed)
  • Subject is allergic or intolerant to aminophylline, nitroglycerin or metoprolol
  • Subject is allergic or intolerant to regadenoson or any of its excipients
  • Subject is unable or unwilling to comply with the procedure schedule
  • Subject has previously enrolled in this study or was enrolled in another regadenoson study sponsored by Astellas
  • Subject has atrial fibrillation or significant arrhythmias which may result in decreased image quality for the imaging studies (CT and SPECT)
  • Subject has high heart rate (> 65 beats per minute) and contra-indications to administer beta-blockers (severe chronic obstructive pulmonary disease (COPD) or asthma, second and third degree atrioventricular block)

Sites / Locations

  • Sutter Roseville Medical Center
  • Harbor UCLA Medical Center
  • Cardiovascular Research Center of South Florida
  • Baptist Hospital of Miami
  • Midwest Cardiology Associates, P.C.
  • Maine Research Associates
  • Massachusetts General Hospital
  • Brigham and Women's Hospital
  • Berkshire Medical Center
  • Henry Ford Health System
  • Oregon Health and Science University

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Single Photon Emission Computed Tomography (SPECT)

Multidetector Computed Tomography (MDCT)

Arm Description

Resting SPECT imaging was performed prior to regadenoson stress SPECT imaging. Imaging was conducted with one of two radiotracers (99mTc sestamibi or tetrofosmin). Regadenoson 0.4 mg was administered prior to stress SPECT as a single bolus injection.

Multidetector Computed Tomography (MDCT), composed of CCTA and regadenoson CTP. Regadenoson stress CTP was performed prior to rest CCTA/CTP imaging. Regadenoson 0.4 mg was administered prior to stress CTP as a single bolus injection. The rest CCTA/CTP was performed at least 30 minutes after completion of the stress CTP, after resolution of any symptoms brought on by the regadenoson infusion and after the participant's heart rate had returned to baseline.

Outcomes

Primary Outcome Measures

Number of Participants With Reversible Defects
The number of reversible defects categorized into absence or presence of ischemia (0-1 versus ≥2), as assessed by the central imaging laboratory for both SPECT and MDCT. The 17-segment model for standardized myocardial segmentation was used for myocardial perfusion readings for SPECT and MDCT. At rest and stress, each segment was scored on a 0 to 4 scale according to the amount of contrast or radiotracer the myocardium in the segment absorbed: 0: normal perfusion 1: slightly reduced contrast/radiotracer uptake 2: moderately reduced contrast/radiotracer uptake 3: severely reduced contrast/radiotracer uptake 4: absent contrast/radiotracer uptake. The median score from the 3 blinded readers for each segment was used. If the stress score was ≥ 2 and the rest score was less than the stress score, the segment was counted as having a reversible defect. A participant was classified as ischemic in the presence of 2 or more segments with reversible defects, excluding segment 17.

Secondary Outcome Measures

Overall Image Quality of Scans by Modality and Reviewer
Overall image quality was assessed by three independent blinded readers for each modality (single photon emission computed tomography (SPECT) and multidetector computed tomography (MDCT)). Image quality was rated on a 4-point scale as either excellent, good, fair or poor at rest using SPECT and MDCT and under stress using regadenoson SPECT and regadenoson stress computed tomography perfusion (CTP).
Number of Participants With Reversible Defects in the Left Anterior Descending Coronary Artery (LAD)
The number of reversible defects in the LAD categorized into absence or presence of ischemia (0-1 versus ≥2), as assessed by the central imaging laboratory for both SPECT and MDCT. The 17-segment model for standardized myocardial segmentation was used for myocardial perfusion readings for SPECT and MDCT. At rest and stress, each segment was scored on a 0 to 4 scale according to the amount of contrast or radiotracer the myocardium in the segment absorbed: 0: normal perfusion 1: slightly reduced contrast/radiotracer uptake 2: moderately reduced contrast/radiotracer uptake 3: severely reduced contrast/radiotracer uptake 4: absent contrast/radiotracer uptake. The median score from 3 blinded readers for each segment was used. If the stress score was ≥ 2 and the rest score was less than the stress score, the segment was counted as having a reversible defect. A participant was classified as ischemic in the presence of ≥ 2 segments with reversible defects, excluding segment 17.
Number of Participants With Reversible Defects in the Right Coronary Artery (RCA)
The number of reversible defects in the RCA categorized into absence or presence of ischemia (0-1 versus ≥2), as assessed by the central imaging laboratory for both SPECT and MDCT. The 17-segment model for standardized myocardial segmentation was used for myocardial perfusion readings for SPECT and MDCT. At rest and stress, each segment was scored on a 0 to 4 scale according to the amount of contrast or radiotracer the myocardium in the segment absorbed: 0: normal perfusion 1: slightly reduced contrast/radiotracer uptake 2: moderately reduced contrast/radiotracer uptake 3: severely reduced contrast/radiotracer uptake 4: absent contrast/radiotracer uptake. The median score from 3 blinded readers for each segment was used. If the stress score was ≥ 2 and the rest score was less than the stress score, the segment was counted as having a reversible defect. A participant was classified as ischemic in the presence of ≥ 2 segments with reversible defects, excluding segment 17.
Number of Participants With Reversible Defects in the Left Circumflex Coronary Artery (LCX)
The number of reversible defects in the LCX categorized into absence or presence of ischemia (0-1 versus ≥2), as assessed by the central imaging laboratory for both SPECT and MDCT. The 17-segment model for standardized myocardial segmentation was used for myocardial perfusion readings for SPECT and MDCT. At rest and stress, each segment was scored on a 0 to 4 scale according to the amount of contrast or radiotracer the myocardium in the segment absorbed: 0: normal perfusion 1: slightly reduced contrast/radiotracer uptake 2: moderately reduced contrast/radiotracer uptake 3: severely reduced contrast/radiotracer uptake 4: absent contrast/radiotracer uptake. The median score from 3 blinded readers for each segment was used. If the stress score was ≥ 2 and the rest score was less than the stress score, the segment was counted as having a reversible defect. A participant was classified as ischemic in the presence of ≥ 2 segments with reversible defects, excluding segment 17.
Number of Participants With Fixed Defects
Using the 17-segment scoring system, a segment scored above 1 (i.e., 2 to 4) and equal at rest and stress was counted as having a fixed defect. At rest and stress, each segment was scored on a 0 to 4 scale according to the amount of contrast or radiotracer the myocardium in the segment absorbed: 0: normal perfusion 1: slightly reduced contrast/radiotracer uptake 2: moderately reduced contrast/radiotracer uptake 3: severely reduced contrast/radiotracer uptake 4: absent contrast/radiotracer uptake.
Percentage of Participants With Two or More Ischemic Segments on SPECT, But Less on CT
Using SPECT as the reference standard, the false negative percentage was calculated as the percentage of participants with two or more ischemic segments on SPECT, but less on CT.

Full Information

First Posted
April 12, 2011
Last Updated
November 21, 2017
Sponsor
Astellas Pharma Inc
search

1. Study Identification

Unique Protocol Identification Number
NCT01334918
Brief Title
A Study of Regadenoson in Subjects Undergoing Stress Myocardial Perfusion Imaging (MPI) Using Multidetector Computed Tomography (MDCT) Compared to Single Photon Emission Computed Tomography (SPECT)
Official Title
A Phase 2, Open-Label, Randomized, Cross-Over Study of Regadenoson in Subjects Undergoing Stress Myocardial Perfusion Imaging by Multidetector Computed Tomography (MDCT) and Single Photon Emission Computed Tomography (SPECT)
Study Type
Interventional

2. Study Status

Record Verification Date
November 2017
Overall Recruitment Status
Completed
Study Start Date
April 26, 2011 (Actual)
Primary Completion Date
July 2, 2012 (Actual)
Study Completion Date
July 2, 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Astellas Pharma Inc

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to compare Multidetector Computed Tomography (MDCT) and Single Photon Emission Computed Tomography (SPECT) stress myocardial perfusion imaging (MPI) with regadenoson in order to detect the presence or absence of reversible defects.
Detailed Description
All participants will be randomized to one of two imaging sequences: rest/stress SPECT on Day 1 followed by stress/rest MDCT on Day 2 or stress/rest MDCT on Day 1 followed by rest/stress SPECT on Day 2. All stress scans will involve the injection of regadenoson as the pharmacologic stress agent.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Artery Disease (CAD)
Keywords
pharmacologic stress, Coronary Artery Disease (CAD), regadenoson, ischemia

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
124 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Single Photon Emission Computed Tomography (SPECT)
Arm Type
Experimental
Arm Description
Resting SPECT imaging was performed prior to regadenoson stress SPECT imaging. Imaging was conducted with one of two radiotracers (99mTc sestamibi or tetrofosmin). Regadenoson 0.4 mg was administered prior to stress SPECT as a single bolus injection.
Arm Title
Multidetector Computed Tomography (MDCT)
Arm Type
Experimental
Arm Description
Multidetector Computed Tomography (MDCT), composed of CCTA and regadenoson CTP. Regadenoson stress CTP was performed prior to rest CCTA/CTP imaging. Regadenoson 0.4 mg was administered prior to stress CTP as a single bolus injection. The rest CCTA/CTP was performed at least 30 minutes after completion of the stress CTP, after resolution of any symptoms brought on by the regadenoson infusion and after the participant's heart rate had returned to baseline.
Intervention Type
Drug
Intervention Name(s)
regadenoson
Other Intervention Name(s)
CVT 3146, Lexiscan
Intervention Description
Administered by intravenous bolus.
Intervention Type
Radiation
Intervention Name(s)
technetium Tc99m sestamibi /technetium Tc99m tetrafosmin
Other Intervention Name(s)
Cardiolite, Myoview
Intervention Description
Administered by intravenous infusion
Intervention Type
Radiation
Intervention Name(s)
Contrast
Intervention Description
Administered by intravenous infusion.
Intervention Type
Procedure
Intervention Name(s)
Single Photon Emission Computed Tomography
Intervention Description
Procedure/Surgery
Intervention Type
Procedure
Intervention Name(s)
Multidetector Computed Tomography
Intervention Description
Procedure/Surgery
Primary Outcome Measure Information:
Title
Number of Participants With Reversible Defects
Description
The number of reversible defects categorized into absence or presence of ischemia (0-1 versus ≥2), as assessed by the central imaging laboratory for both SPECT and MDCT. The 17-segment model for standardized myocardial segmentation was used for myocardial perfusion readings for SPECT and MDCT. At rest and stress, each segment was scored on a 0 to 4 scale according to the amount of contrast or radiotracer the myocardium in the segment absorbed: 0: normal perfusion 1: slightly reduced contrast/radiotracer uptake 2: moderately reduced contrast/radiotracer uptake 3: severely reduced contrast/radiotracer uptake 4: absent contrast/radiotracer uptake. The median score from the 3 blinded readers for each segment was used. If the stress score was ≥ 2 and the rest score was less than the stress score, the segment was counted as having a reversible defect. A participant was classified as ischemic in the presence of 2 or more segments with reversible defects, excluding segment 17.
Time Frame
Day 1 and Day 2
Secondary Outcome Measure Information:
Title
Overall Image Quality of Scans by Modality and Reviewer
Description
Overall image quality was assessed by three independent blinded readers for each modality (single photon emission computed tomography (SPECT) and multidetector computed tomography (MDCT)). Image quality was rated on a 4-point scale as either excellent, good, fair or poor at rest using SPECT and MDCT and under stress using regadenoson SPECT and regadenoson stress computed tomography perfusion (CTP).
Time Frame
Day 1 and Day 2
Title
Number of Participants With Reversible Defects in the Left Anterior Descending Coronary Artery (LAD)
Description
The number of reversible defects in the LAD categorized into absence or presence of ischemia (0-1 versus ≥2), as assessed by the central imaging laboratory for both SPECT and MDCT. The 17-segment model for standardized myocardial segmentation was used for myocardial perfusion readings for SPECT and MDCT. At rest and stress, each segment was scored on a 0 to 4 scale according to the amount of contrast or radiotracer the myocardium in the segment absorbed: 0: normal perfusion 1: slightly reduced contrast/radiotracer uptake 2: moderately reduced contrast/radiotracer uptake 3: severely reduced contrast/radiotracer uptake 4: absent contrast/radiotracer uptake. The median score from 3 blinded readers for each segment was used. If the stress score was ≥ 2 and the rest score was less than the stress score, the segment was counted as having a reversible defect. A participant was classified as ischemic in the presence of ≥ 2 segments with reversible defects, excluding segment 17.
Time Frame
Day 1 and Day 2
Title
Number of Participants With Reversible Defects in the Right Coronary Artery (RCA)
Description
The number of reversible defects in the RCA categorized into absence or presence of ischemia (0-1 versus ≥2), as assessed by the central imaging laboratory for both SPECT and MDCT. The 17-segment model for standardized myocardial segmentation was used for myocardial perfusion readings for SPECT and MDCT. At rest and stress, each segment was scored on a 0 to 4 scale according to the amount of contrast or radiotracer the myocardium in the segment absorbed: 0: normal perfusion 1: slightly reduced contrast/radiotracer uptake 2: moderately reduced contrast/radiotracer uptake 3: severely reduced contrast/radiotracer uptake 4: absent contrast/radiotracer uptake. The median score from 3 blinded readers for each segment was used. If the stress score was ≥ 2 and the rest score was less than the stress score, the segment was counted as having a reversible defect. A participant was classified as ischemic in the presence of ≥ 2 segments with reversible defects, excluding segment 17.
Time Frame
Day 1 and Day 2
Title
Number of Participants With Reversible Defects in the Left Circumflex Coronary Artery (LCX)
Description
The number of reversible defects in the LCX categorized into absence or presence of ischemia (0-1 versus ≥2), as assessed by the central imaging laboratory for both SPECT and MDCT. The 17-segment model for standardized myocardial segmentation was used for myocardial perfusion readings for SPECT and MDCT. At rest and stress, each segment was scored on a 0 to 4 scale according to the amount of contrast or radiotracer the myocardium in the segment absorbed: 0: normal perfusion 1: slightly reduced contrast/radiotracer uptake 2: moderately reduced contrast/radiotracer uptake 3: severely reduced contrast/radiotracer uptake 4: absent contrast/radiotracer uptake. The median score from 3 blinded readers for each segment was used. If the stress score was ≥ 2 and the rest score was less than the stress score, the segment was counted as having a reversible defect. A participant was classified as ischemic in the presence of ≥ 2 segments with reversible defects, excluding segment 17.
Time Frame
Day 1 and Day 2
Title
Number of Participants With Fixed Defects
Description
Using the 17-segment scoring system, a segment scored above 1 (i.e., 2 to 4) and equal at rest and stress was counted as having a fixed defect. At rest and stress, each segment was scored on a 0 to 4 scale according to the amount of contrast or radiotracer the myocardium in the segment absorbed: 0: normal perfusion 1: slightly reduced contrast/radiotracer uptake 2: moderately reduced contrast/radiotracer uptake 3: severely reduced contrast/radiotracer uptake 4: absent contrast/radiotracer uptake.
Time Frame
Day 1 and Day 2
Title
Percentage of Participants With Two or More Ischemic Segments on SPECT, But Less on CT
Description
Using SPECT as the reference standard, the false negative percentage was calculated as the percentage of participants with two or more ischemic segments on SPECT, but less on CT.
Time Frame
Day 1 and Day 2

10. Eligibility

Sex
All
Minimum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male subjects must be ≥ 45 years of age Female subjects must be ≥ 50 years of age Subject has met at least one of the following three criteria: has a suspected (clinical impression) or known diagnosis of coronary artery disease (CAD) with typical angina that has been referred from nuclear cardiology lab schedule or cardiac computed tomography (CT) schedule has stable symptoms with possible elective catheterization procedure scheduled and where further imaging may be beneficial; has known CAD from a previous invasive coronary angiography (ICA) performed more than 12 weeks prior to screening who now present with new cardiac symptoms Subject has been referred for a clinically indicated myocardial perfusion imaging procedure or Cardiac CT procedure for suspected moderate or high risk CAD Subject must abstain from eating and drinking 30 minutes prior and 30 minutes post study drug administration Subject must abstain from smoking 3 hours prior and 8 hours post study drug administration Subject must abstain from any intake of methylxanthine-containing foods and beverages within 12 hours prior to Day 1 visit through the Day 3 Follow-Up Visit, as these foods may alter regadenoson effects. Subject is able to safely abstain from theophylline use for 12 hours prior to study drug administration Exclusion Criteria: Subject is concurrently participating in another drug study or has received an investigational drug within 30 days prior to Screening Subject has a history of a clinically significant illness (other than CAD), medical condition, or laboratory abnormality, which would preclude participation in the study Subject has renal dysfunction demonstrated by a glomerular filtration rate (GFR) < 45 mL/min (calculated using Cockroft-Gault formula Note: Subjects with a GFR 45-60 mL/min will undergo a hydration procedure Female subject who is pregnant, lactating or of childbearing potential that refuses to use a medically acceptable form of contraception until the Telephone Follow up Visit is complete Female subject has a positive pregnancy test prior to randomization Subject has a history of second or third degree heart block or sinus node dysfunction unless the subject has a functioning pacemaker Subject has symptomatic hypotension (temporary and reversible conditions that no longer exist are allowed) Subject is allergic or intolerant to aminophylline, nitroglycerin or metoprolol Subject is allergic or intolerant to regadenoson or any of its excipients Subject is unable or unwilling to comply with the procedure schedule Subject has previously enrolled in this study or was enrolled in another regadenoson study sponsored by Astellas Subject has atrial fibrillation or significant arrhythmias which may result in decreased image quality for the imaging studies (CT and SPECT) Subject has high heart rate (> 65 beats per minute) and contra-indications to administer beta-blockers (severe chronic obstructive pulmonary disease (COPD) or asthma, second and third degree atrioventricular block)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Senior Medical Director
Organizational Affiliation
Astellas Pharma Global Development
Official's Role
Study Director
Facility Information:
Facility Name
Sutter Roseville Medical Center
City
Roseville
State/Province
California
ZIP/Postal Code
95661
Country
United States
Facility Name
Harbor UCLA Medical Center
City
Torrance
State/Province
California
ZIP/Postal Code
90502
Country
United States
Facility Name
Cardiovascular Research Center of South Florida
City
Miami
State/Province
Florida
ZIP/Postal Code
33173
Country
United States
Facility Name
Baptist Hospital of Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33176
Country
United States
Facility Name
Midwest Cardiology Associates, P.C.
City
Overland Park
State/Province
Kansas
ZIP/Postal Code
66029
Country
United States
Facility Name
Maine Research Associates
City
Auburn
State/Province
Maine
ZIP/Postal Code
04210
Country
United States
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Brigham and Women's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Berkshire Medical Center
City
Pittsfield
State/Province
Massachusetts
ZIP/Postal Code
01201
Country
United States
Facility Name
Henry Ford Health System
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48202
Country
United States
Facility Name
Oregon Health and Science University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Details of the IPD sharing plan for this study can be found at www.clinicalstudydatarequest.com.
Citations:
PubMed Identifier
24314823
Citation
Cury RC, Kitt TM, Feaheny K, Akin J, George RT. Regadenoson-stress myocardial CT perfusion and single-photon emission CT: rationale, design, and acquisition methods of a prospective, multicenter, multivendor comparison. J Cardiovasc Comput Tomogr. 2014 Jan-Feb;8(1):2-12. doi: 10.1016/j.jcct.2013.09.004. Epub 2013 Oct 18.
Results Reference
derived
Links:
URL
https://astellasclinicalstudyresults.com/study.aspx?ID=225
Description
Link to results on the Astellas Clinical Study Results website.

Learn more about this trial

A Study of Regadenoson in Subjects Undergoing Stress Myocardial Perfusion Imaging (MPI) Using Multidetector Computed Tomography (MDCT) Compared to Single Photon Emission Computed Tomography (SPECT)

We'll reach out to this number within 24 hrs