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NMP: nuclear medicine physician; NMR: nuclear medicine resident; SNRN: sentinel node referent nurse; DIT: diagnostic imaging technician.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Ribera-Perianes, M. Vega, X. Cases Moreno, J. Cordón, J. Cortés Gracia, P. Paredes, N. Sánchez-Izquierdo, A. Perissinotti, D. Fuster Pelfort, S. Vidal-Sicart" "autores" => array:10 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Ribera-Perianes" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Vega" ] 2 => array:2 [ "nombre" => "X." "apellidos" => "Cases Moreno" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Cordón" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Cortés Gracia" ] 5 => array:2 [ "nombre" => "P." "apellidos" => "Paredes" ] 6 => array:2 [ "nombre" => "N." "apellidos" => "Sánchez-Izquierdo" ] 7 => array:2 [ "nombre" => "A." "apellidos" => "Perissinotti" ] 8 => array:2 [ "nombre" => "D." "apellidos" => "Fuster Pelfort" ] 9 => array:2 [ "nombre" => "S." 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Esteban Hurtado, J. Orozco Cortés, P. Cárcamo Ibarra, U. López González, Á. Badenes Romero, M.Á. Navas de la Cruz, C. Siscar Gelo, L. Casas Calabuig, P. Abreu Sánchez, T. Mut Dólera, D. Balaguer Muñoz, M.D. Reyes Ojeda, C. Plancha Mansanet, E. Caballero Calabuig" "autores" => array:14 [ 0 => array:2 [ "nombre" => "Á." "apellidos" => "Esteban Hurtado" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Orozco Cortés" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Cárcamo Ibarra" ] 3 => array:2 [ "nombre" => "U." "apellidos" => "López González" ] 4 => array:2 [ "nombre" => "Á." "apellidos" => "Badenes Romero" ] 5 => array:2 [ "nombre" => "M.Á." "apellidos" => "Navas de la Cruz" ] 6 => array:2 [ "nombre" => "C." "apellidos" => "Siscar Gelo" ] 7 => array:2 [ "nombre" => "L." "apellidos" => "Casas Calabuig" ] 8 => array:2 [ "nombre" => "P." "apellidos" => "Abreu Sánchez" ] 9 => array:2 [ "nombre" => "T." "apellidos" => "Mut Dólera" ] 10 => array:2 [ "nombre" => "D." 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"apellidos" => "Caballero Calabuig" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X23001117" "doi" => "10.1016/j.remn.2023.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X23001117?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808924000132?idApp=UINPBA00004N" "url" => "/22538089/0000004300000002/v1_202403210524/S2253808924000132/v1_202403210524/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Role of the clinical radiopharmacist in patient safety during myocardial perfusion imaging with vasodilator stress agents" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "84" "paginaFinal" => "90" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. Salgado-Garcia, A. Moreno-Ballesteros, P. Guardia-Jimena, E. Sanchez-de-Mora, A.C. Rebollo-Aguirre, A. Ramirez-Navarro, A. Santos-Bueno, A. Jimenez-Heffernan" "autores" => array:8 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Salgado-Garcia" "email" => array:1 [ 0 => "carlos.salgado.garcia@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Moreno-Ballesteros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "P." "apellidos" => "Guardia-Jimena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Sanchez-de-Mora" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "A.C." "apellidos" => "Rebollo-Aguirre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "A." "apellidos" => "Ramirez-Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "A." "apellidos" => "Santos-Bueno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 7 => array:3 [ "nombre" => "A." "apellidos" => "Jimenez-Heffernan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Radiopharmacy Unit (Department of Nuclear Medicine), Hospital Juan Ramon Jimenez, Huelva, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Nuclear Medicine, Hospital Juan Ramon Jimenez, Huelva, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Radiopharmacy Unit (Department of Nuclear Medicine), Hospital Virgen de las Nieves, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel del radiofarmacéutico clínico en la seguridad del paciente en estudios de perfusión miocárdica con agentes vasodilatadores de estrés farmacológico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1556 "Ancho" => 3495 "Tamanyo" => 211202 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Contraindications that precluded performing the stress test.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Interventional medications in Nuclear Medicine (NM) are pharmaceuticals employed to induce a specific physiological or biochemical response and facilitate or enhance the biodistribution of radiopharmaceuticals. Myocardial perfusion imaging (MPI) uses pharmaceuticals as agents for pharmacologic stress. MPI is widely used in the diagnostic and prognostic work-up of patients with coronary artery disease (CAD).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Exercise is the preferred stress modality in patients who are able to exercise to an adequate workload, treadmill exercise being the most widely used modality. However, for patients unable to perform adequate exercise stress due to physical limitations or medical constraints, pharmacologic stress is indicated.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Adenosine and regadenoson are vasodilators that increase myocardial blood flow by stimulating adenosine A<span class="elsevierStyleInf">2A</span> receptors, leading to coronary arteriolar dilation. Adenosine is a non-selective agonist of all subtypes of adenosine receptors producing undesirable side effects such as heart block, bronchospasm, dyspnea, nausea, etc, due to its action on A<span class="elsevierStyleInf">1</span>, A<span class="elsevierStyleInf">2B</span>, and A<span class="elsevierStyleInf">3</span> receptors. In contrast, regadenoson is a selective adenosine A<span class="elsevierStyleInf">2A</span> receptor agonist approved for use in MPI<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> with a safer and better tolerability profile.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> In addition regadenoson is easier to use (single bolus, and standard dose, unlike adenosine) making it the most widely used pharmacologic agent for stress testing in the United States and Europe.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> For this reason, regadenoson is the first-choice or default stress agent for pharmacologic stress MPI. Nevertheless, regadenoson has contraindications that should be taken into account in patients with history of seizures or epilepsy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The clinical pharmacist is defined by the American College of Clinical Pharmacy (ACCP) as an allied health profession that “works directly with physicians, other health professionals and patients to ensure that medications prescribed for patients contribute to the best possible outcomes”.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Clinical pharmacists in the US and Europe have established roles in many healthcare teams contributing to patient safety as part of a multiprofessional teams both for acute and primary care,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> respectively. Patient safety is a serious global public health problem and is considered as a key pillar of quality care by WHO and public health systems to implement strategies aiming to reduce the incidence of adverse events.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In an analogous way, the radiopharmacist can undertake responsibility for providing both radiopharmaceutical and pharmaceutical care to patients, which includes supplying information to the nuclear physician (NP), assessing outcomes of procedures and interventions as well as potential adverse effects or contraindications that may be important in specific patients.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In this sense, the use of pharmacologic vasodilator stress agents has some limitations and clinical contraindications<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,13</span></a> that must be identified before the patient undergoes stress MPI. Considering clinical pharmacy as part of radiopharmacy practice, radiopharmacists (through training and experience) can acquire skills to recognize patients with an increased risk of complications and identify relative and absolute contraindications for the stress test. The objective of this study was to assess the role of the radiopharmacist in a multidisciplinary team with NP and nurse staff, focused on the clinical contraindications of pharmacologic vasodilator (regadenoson or adenosine if regadenoson is contraindicated) in order to ensure its safe use in patients undergoing stress MPI.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This quasi-experimental study is an ambispective analysis of clinical radiopharmacist intervention in the safe use of regadenoson in 1905 consecutive patients undergoing a clinically indicated pharmacologic stress SPECT-MPI, recruited from October 2018 through August 2022.</p><p id="par0025" class="elsevierStylePara elsevierViewall">On a daily basis, the radiopharmacist collected the incoming requests for MPI and registered the following variables for every patient using a standardized Microsoft Office Excel® spreadsheet: administrative data, sex, age, medical history, medications, drug allergies or adverse drug reactions (ADR), electrocardiogram (ECG), echocardiogram, coronary angiography, supra-aortic vessels imaging (RM, CT, echo Doppler), laboratory tests, spirometry and other.</p><p id="par0030" class="elsevierStylePara elsevierViewall">After careful evaluation of each patient’s medical record, if a potential or manifested problem or contraindication was detected, the radiopharmacist interacted with the NP and nursing team, to deliver the best recommendation by means of a written report (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The radiopharmacist’s interventions were evaluated by acceptance rate (accepted or not accepted, if the NP implemented or not the change suggested by the radiopharmacist), and finally nursing performed the implementation of the final recommendations and carried out the care of the patient during the course of the test.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Descriptive statistics were used to summarize sociodemographic characteristics, potential problems or contraindications for stress testing, recommendations provided by the radiopharmacist to NPs and grade of acceptance. Continuous variables were presented as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation (SD) and categorical variables were reported as frequencies and proportions.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ethical approval</span><p id="par0045" class="elsevierStylePara elsevierViewall">This study was performed under the principles of the Declaration of Helsinki. Approval was granted by the Coordinating Committee on Biomedical Research Ethics of Andalusia (protocol code CSG-RADIOFARMA 0445-N-22). Informed consent of the patients was not required. There was no deviation from regular clinical practice as the study comprised the radiopharmacist’s contributions to the multidisciplnary team.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Characteristics of the study population</span><p id="par0050" class="elsevierStylePara elsevierViewall">From October 2018 to August 2022, 1905 patients (54.1% female) with a mean age of 66.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.7 years (range 20–95 years) undergoing MPI stress testing were evaluated for the safe use of regadenoson by the clinical radiopharmacist in the NM Department. 188 of them were inpatients (9.9%). Patients were referred from the departments of Cardiology, Internal Medicine, Nephrology and Pneumology (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Patient’s clinical information was retrieved through the Andalusian eHealth Strategy system (DIRAYA).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The time taken by the radiopharmacist to assess each patient was between 10 and 25<span class="elsevierStyleHsp" style=""></span>min. This evaluation did not add any excess time to delay in performing the test.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Contraindications detected by the clinical radiopharmacist</span><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> displays the regadenoson contraindications and drug interactions detected by the radiopharmacist, their potential consequences and the recommendations suggested to the NP for avoiding or minimizing potential adverse events. No contraindications were detected in 73.6% of patients. The comparison between outpatients and inpatients groups (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) showed that chronic obstructive pulmonary disease (COPD) patients treated with systemic corticosteroids and patients with exacerbation of COPD were more frequent among the latter. All the rest of contraindications were more frequent in outpatients.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Contraindications precluding performance of the stress test</span><p id="par0065" class="elsevierStylePara elsevierViewall">The radiopharmacist detected 56 patients (2.9%) with absolute contraindications for MPI and the NP decided to cancel the test, 14 of them representing inpatients (25.0%). This means that 10.9% of the patients who presented some drug interaction or clinical contraindication (56/503 contraindications) did not undergo the test. <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> shows contraindications that precluded performing the stress test. <span class="elsevierStyleItalic">“Other causes”</span> of absolute contraindications included elevated cardiac troponins levels in hospitalized patients, severe valve stenosis, severe pericardial effusion and respiratory instability.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Nuclear physician acceptance rate</span><p id="par0070" class="elsevierStylePara elsevierViewall">Recommendations given by the radiopharmacist were well received and 100% of them were accepted by the NPs, who modified their approach to the patient.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Doubtful or controversial cases (43/1905, 0.02%) (medical conditions that were considered as no clear absolute contraindications, such as patients with previous stroke/TIA and no image techniques registered, or patients with comorbidities such as epilepsy plus bronchoconstrictive disease) with were discussed in scheduled clinical sessions with all the medical staff (6 NM physcians), and consensus solutions were reached. The frequency of these meetings was once or twice a month, and the followed methodology was brainstorming.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Our study is focused on a new radiopharmacist — nuclear physician collaboration model based on the addition of the radiopharmacist to carry out a double-check on drug prescriptions, especially regarding the interactions with other pharmaceuticals and pathophysiological medical status of the patient such as diseases, allergies and other conditions regarding the pharmacologic stress test.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In this sense, there are only a few studies in which authors report the role of radiopharmacists as a barrier to avoid severe adverse events and identify clinical contraindications of Nuclear Medicine tests.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14–16</span></a> Moreover, none of them deal specifically with the safe use of regadenoson in patients undergoing MPI. However, several studies have shown that clinical pharmacists have contributed to improve patient outcomes.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17–19</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In this ambispective study, the clinical radiopharmacist identified drug interactions or clinical contraindications of regadenoson in 26.4% of the requested MPI studies. The most common finding was the presence of several factors that may cause prolongation of the corrected-QT (QTc) interval on the electrocardiogram after the administration of regadenoson, such as medications known to cause QTc interval prolongation,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> female sex, age >65 years, bradycardia, untreated thyroid disease, electrolyte disturbance, or recent cardioversion with QT-prolonging drugs. Long QT interval increases the risk of the life-threatening ventricular arrhythmia known as <span class="elsevierStyleItalic">torsades de pointes</span> (TdP). The Tisdale score can be used to assess the risk for developing TdP.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> The clinical radiopharmacist’s knowledge of drug interactions most likely to result in TdP enables her or him to play an important role in assessing the risk of QTc interval prolongation.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21–23</span></a> Overall, 142 patients (7.5%) were at risk of QT prolongation, and the recommendation was to measure the QTc interval calculated with the Bazzet’s formula, and if normal proceed with the regadenoson administration but with extra vigilance of the ECG during the test. The test was not performed in 4 of these patients (2.8%) because the measured QTc interval just before was >450<span class="elsevierStyleHsp" style=""></span>ms for males and >470<span class="elsevierStyleHsp" style=""></span>ms for females. Thus, analysis of these risk factors by the radiopharmacist contributes to help the NP to be extravigilant in these patients.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Other frequently detected issue was prior stroke or transient ischemic attack (TIA) in 79 patients (4.2%). The radiopharmacist recommended to consider carotid stenosis assessment by routine vascular imaging techniques.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Following these procedures, 20 patients (37% of patients with prior stroke or TIA) had an absolute contraindication for the use of vasodilator stress agents in SPECT-MPI. After the recommendation given by the radiopharmacist, the NP cancelled the test.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Moreover, 47 patients with epilepsy or pre-existing risk factors for seizures (5.8%) were detected in our study. Seizure is a post-marketing adverse event of regadenoson with an increasing incidence.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> This is due to regadenoson’s specific stimulation of A<span class="elsevierStyleInf">2A</span> receptors distributed in the CNS (cerebral cortex, striatum, nucleus accumbens, and hippocampus),<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> involved in the enhancement of glutamatergic response and excitatory neurotransmission between neurons, leading to potential proconvulsive activity.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> For this reason, the recommendation is to avoid using regadenoson in patients with epilepsy<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> or patients with pre-existing risk factors and in patients receiving treatment with drugs that can lower seizure threshold.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> In our study these drugs were mostly antidepressants, neuroleptics, and smoking cessation treatments. However, adenosine A<span class="elsevierStyleInf">1</span> receptors are highly expressed in areas of the CNS and when activated they lead to stabilization of the cell membrane and mediate seizure arrest by raising its threshold.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> This make adenosine itself neuroprotective<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> and could be a safer option than regadenoson in patients with risk factors of seizures and without bronchoconstrictive disease. In spite of this, it is very important that the radiopharmacist reports that theophylline is contraindicated in patients with convulsive seizures after stress agent administration because it may increase or prolong seizures. NP and nurses need to be aware of this adverse event and appropriate acute seizure termination measures must be always accessible, such as intravenous benzodiazepines (i.e., diazepam 10<span class="elsevierStyleHsp" style=""></span>mg).</p><p id="par0105" class="elsevierStylePara elsevierViewall">Other detected issue was not for regadenoson but for the MPI radiopharmaceutical. <span class="elsevierStyleSup">99m</span>Tc-tetrofosmin is the MPI radiopharmaceutical of choice in our department. However, the package insert of the tetrofosmin kit indicates “hypersensitivity to […] excipients” such as the transfer ligand disodium sulphosalycilate,<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> showing a similar chemical structure to salicylates and sulfonamides. The alternative MPI radiopharmaceutical <span class="elsevierStyleSup">99m</span>Tc-sestamibi (not containing this excipient) is considered to be a safer option for patients with previous allergic reactions to salicylates and/or sulfonamides. In fact, none of the patients in the <span class="elsevierStyleSup">99m</span>Tc-sestamibi group showed any symptoms of an allergic reaction.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Moreover, we found some differences between the contraindications of outpatients vs inpatients. Thus, some medical conditions such as respiratory instability (i.e., exacerbated COPD), altered laboratory findings (elevated cardiac troponins) or unstable pericardial effusion were more frequent among the latter.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Our findings show that multidisciplinary teams constitute an optimal opportunity for radiopharmacists to closely collaborate with NP. The ability of the radiopharmacist to achieve this new role is called for as they have the required knowledge in Nuclear Cardiology procedures.</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Study limitations</span><p id="par0120" class="elsevierStylePara elsevierViewall">This study was subject to certain limitations, such as the absence of a control group to compare between cases with and without radiopharmacist intervention. As a result, it was difficult to know if the intervention was the sole cause to avoid the detection of potentially dangerous clinical problems for vasodilators stress testing.</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusion</span><p id="par0125" class="elsevierStylePara elsevierViewall">The radiopharmacist was able, with a systematic approach, to detect a high number of issues related to the safe use of regadenoson in MPI studies with one out of four patients presenting some drug interaction or clinical contraindication. The recommendations given by the radiopharmacist were well received and accepted by the NPs who changed their approach, thus contributing to increase the safety of patients referred for MPI. The clinical activity of the radiopharmacists is enhanced and many opportunities are identified. It is important that NPs and nurses understand the role of radiopharmacists as clinical providers in NM Departments, especially in Nuclear Cardiology.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors confirm that we have no financial support or other benefits form commercial sources for the work reported on in the manuscript, or any other financial interest which could create a potential conflict of interest or the appearance of a conflict of interest regarding the work.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2110997" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1798198" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2110998" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1798199" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Ethical approval" ] ] ] 6 => array:3 [ "identificador" => "sec0025" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Characteristics of the study population" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Contraindications detected by the clinical radiopharmacist" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Contraindications precluding performance of the stress test" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Nuclear physician acceptance rate" ] ] ] 7 => array:3 [ "identificador" => "sec0050" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Study limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-08-08" "fechaAceptado" => "2023-11-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1798198" "palabras" => array:5 [ 0 => "Myocardial perfusion imaging" 1 => "Pharmacologic stress" 2 => "Clinical pharmacy" 3 => "Radiopharmacist" 4 => "Patient safety" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1798199" "palabras" => array:5 [ 0 => "Imagen de perfusión miocárdica" 1 => "Estrés farmacológico" 2 => "Farmacia clínica" 3 => "Radiofarmacéutico" 4 => "Seguridad del paciente" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aim</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To assess the radiopharmacist’s role in a multidisciplinary team focused on the contraindications of regadenoson in order to ensure the safe use of pharmacologic vasodilator stress agents in patients undergoing SPECT-MPI.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We ambispectively studied its safe use in 1905 patients (54.1% female, mean age: 66.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.7 years, range: 20–95 years). Sex, age, medical history, medications, drug allergies, and contraindications for stress testing were registered together with recommendations for the nuclear physician in charge.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Detected contraindications and corresponding recommendations were as follows: risk factors for QTc interval prolongation 7.5% – measurement of QTc interval previously to test and monitor ECG; prior stroke or TIA 4.2% – consider carotid stenosis assessment; salicylates/sulfonamides allergy 3.1% – use <span class="elsevierStyleSup">99m</span>Tc-sestamibi; epilepsy or risk factors for seizures 2.4% – use of adenosine or reconsider test indication; systemic corticosteroid therapy for severe COPD 1.3% – reassessment of patient’s condition; acute exacerbation of COPD 0.8% – defer test until acute episode is over; severe asthma 0.4% – do not perform test; methylxanthine ingestion 0.3% – avoid consumption previously; other 6.1% – evaluation of other contraindications. No contraindications were detected in 73.6% of patients. The test was canceled due to absolute contraindications in 2.9% of the requests.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Working in a systematic way, the radiopharmacist was able to detect a high number of issues related to regadenoson, with one out of four patients presenting some clinical contraindication. The recommendations given by the radiopharmacist were well accepted by the nuclear physicians who changed their approach contributing to increase the safety of patients referred for MPI.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Evaluar el papel del radiofarmacéutico en un equipo multidisciplinar en la detección de contraindicaciones del regadenosón para su uso seguro en pacientes a los que se les solicitó una <span class="elsevierStyleItalic">Single Photon Emission Computed Tomography</span> (SPECT) de perfusión miocárdica.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se estudió ambispectivamente su uso seguro en 1.905 pacientes (54,1% mujeres, edad media: 66,6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11,7, rango: 20–95). Se registraron datos de género, edad, historial médico, medicación, alergias medicamentosas y contraindicaciones para el estrés farmacológico, así como las recomendaciones realizadas al médico nuclear responsable.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Las contraindicaciones detectadas y las correspondientes recomendaciones fueron las siguientes: riesgo de prolongación del intervalo QT corregido por la frecuencia cardiaca (QTc) (7,5%) – comprobación previa del intervalo QTc y monitorización del electrocardiograma (ECG), ictus o accidente isquémico transitorio (AIT) previo (4,2%) – evaluación de estenosis carotídea, alergia a salicilatos y/o sulfamidas (3,1%) – empleo de <span class="elsevierStyleSup">99m</span>Tc-sestamibi, epilepsia o riesgo de convulsiones (2,4%) – uso de adenosina o reconsiderar indicación, tratamiento con corticoesteroides sistémicos en enfermedad pulmonar obstructiva crónica (EPOC) severa (1,3%) – reevaluar condiciones del paciente; exacerbación de EPOC (0,8%) – posponer hasta resolución del episodio agudo; asma grave (0,4%) – no realizar la prueba; toma de metilxantinas (0,3%) – evitar su consumo previo; otras (6,1%) – evaluación de cada restricción. No se observó rechazo en 73,6% de los usuarios. Se anularon 2,9% de las peticiones debido a contraindicaciones absolutas.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Trabajando de forma sistemática, el radiofarmacéutico detectó un elevado número de incidencias, presentando uno de cada cuatro pacientes alguna contraindicación clínica. Las recomendaciones dadas fueron aceptadas por los médicos nucleares, que modificaron su enfoque, incrementando así la seguridad de estos usuarios.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3099 "Ancho" => 2475 "Tamanyo" => 458767 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0065" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Report of the clinical radiopharmacist to the nuclear medicine physician in charge.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2230 "Ancho" => 2559 "Tamanyo" => 273832 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0070" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Comparison of contraindications between outpatient and inpatient groups.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1556 "Ancho" => 3495 "Tamanyo" => 211202 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Contraindications that precluded performing the stress test.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0080" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cardiology \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Internal Medicine \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nephrology \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pneumology \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Outpatients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1368 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">284 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inpatients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">142 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1510 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">328 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3491046.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical referral department.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0085" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Situation or contraindication \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Potential consequence \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendation \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risk factors for QTc interval prolongation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">142 (7.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serious arrhythmias (<span class="elsevierStyleItalic">torsades de pointes</span>) or death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Previous measurement of QTc interval<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prior stroke or TIA<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 (4.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cerebrovascular insufficiency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Carotid stenosis assessment<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epilepsy or history of seizures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Exacerbation of seizures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Either reconsider test indication or perform with adenosine as the stress agent<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risk factors that could lower seizure threshold \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (0.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Seizures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use adenosine as the stress agent<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe asthma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (0.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe bronchoconstriction or death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not perform the test \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Systemic corticosteroid therapy for severe COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (1.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe dyspnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reassessment of patient’s condition on the appointment day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acute exacerbation of COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (0.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe dyspnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Defer test until acute episode is over \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Salycilates allergy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 (2.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Allergic reaction or anaphylaxis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use <span class="elsevierStyleSup">99m</span>Tc-sestamibi as the radiopharmaceutical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sulfonamides allergy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (0.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Allergic reaction or anaphylixis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use <span class="elsevierStyleSup">99m</span>Tc-sestamibi as the radiopharmaceutical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Methylxantine ingestion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (0,3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Decreased test sensitivity (false negative) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Avoid consumption food/beverages containing methylxantine for at least 12<span class="elsevierStyleHsp" style=""></span>h and theophylline during 1–5 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">116 (6.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evaluation of other contraindications \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3491045.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">If long do not perform test. If normal, go ahead but with close monitorization of interval during test.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">TIA<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>transient ischemic attack.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">If degree of arterial stenosis <50%, go ahead. If significant carotid artery stenosis do not perform test due to higher risk of cerebrovascular insufficiency should hypotension occur following regadenoson or adenosine administration.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">In patients without bronchoconstrictive disease.</p>" ] 4 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Pericardial effusion, pulmonary thromboembolism, decompensated congestive heart failure, severe valve stenosis, wheezes audible by chest auscultation.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Situations and contraindications found by the radiopharmacist and corresponding recommendation to the nuclear physician.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ASNC imaging guidelines for nuclear cardiology procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. 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