Safety and Feasibility of Regadenoson Use for Suboptimal Heart Rate Response During Symptom-limited Standard Bruce Exercise Stress Test

Overview

Journal J Nucl Cardiol

Specialty Cardiology & Vascular Diseases

Date 2012 May 9

PMID 22565239

Citations 25

Authors

Sara L Partington

Viswanatha Lanka

Jon Hainer

Ron Blankstein

Hicham Skali

Daniel E Forman

Marcelo F Di Carli

Sharmila Dorbala

Affiliations

Soon will be listed here.

Abstract

Background: Regadenoson during exercise stress test (ETT) can provide maximal hyperemia for myocardial perfusion imaging (MPI), along with exercise information. Our aim was to study the feasibility and safety of regadenoson injection at peak ETT for submaximal heart rate (HR) response.

Methods: Consecutive patients who underwent SPECT MPI with standard Bruce ETT or supine-regadenoson (Supine-Reg) were analyzed. ETT patients were grouped as ETT-Max [maximal HR > 0.85 * (220 - age), N = 1,522], ETT-Submax (submaximal HR no regadenoson, N = 504), ETT-Reg (submaximal HR and regadenoson, N = 211).

Results: The HR during ETT was submaximal in 715 (32%) patients. Of these, 211 patients (30%) underwent ETT-Reg (mean exercise duration: 5.5 ± 2.5 minutes). ETT-Reg patients had a higher frequency of hypertension, diabetes, smoking and beta-blocker use, similar rest systolic blood pressure (SBP), but lower rest and peak HR and peak SBP compared to ETT-Max patients. There were no serious complications with regadenoson. Side effects (49% vs 6%, P < .0001) were fewer and aminophylline use was lower with ETT-Reg compared to Supine-Reg (0.5% vs 8.1%, P = .001).

Conclusions: Submaximal HR response to ETT is common. ETT-Reg is safe, feasible, and well-tolerated. ETT-Reg facilitates a diagnostic MPI with reporting of functional capacity, exercise ECG/hemodynamic changes and MPI at maximal hyperemia.

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References

Ross M, Wu E, Wilkins J, Gupta D, Shen S, Aulwes D . Safety and feasibility of adjunctive regadenoson injection at peak exercise during exercise myocardial perfusion imaging: The Both Exercise and Regadenoson Stress Test (BERST) trial. J Nucl Cardiol. 2013; 20(2):197-204. DOI: 10.1007/s12350-013-9679-1. View

Holly T, Satran A, Bromet D, Mieres J, Frey M, Elliott M . The impact of adjunctive adenosine infusion during exercise myocardial perfusion imaging: Results of the Both Exercise and Adenosine Stress Test (BEAST) trial. J Nucl Cardiol. 2003; 10(3):291-6. DOI: 10.1016/s1071-3581(02)43236-9. View

Gulati M, Black H, Shaw L, Arnsdorf M, Merz C, Lauer M . The prognostic value of a nomogram for exercise capacity in women. N Engl J Med. 2005; 353(5):468-75. DOI: 10.1056/NEJMoa044154. View

Iskandrian A, Bateman T, Belardinelli L, Blackburn B, Cerqueira M, Hendel R . Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: results of the ADVANCE phase 3 multicenter international trial. J Nucl Cardiol. 2007; 14(5):645-58. DOI: 10.1016/j.nuclcard.2007.06.114. View

Hachamovitch R, Berman D, Kiat H, Cohen I, Cabico J, Friedman J . Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation. 1996; 93(5):905-14. DOI: 10.1161/01.cir.93.5.905. View

Kwon D, Cerqueira M, Young R, Houghtaling P, Lieber E, Menon V . Lessons from regadenoson and low-level treadmill/regadenoson myocardial perfusion imaging: initial clinical experience in 1263 patients. J Nucl Cardiol. 2010; 17(5):853-7. DOI: 10.1007/s12350-010-9229-z. View

Buus N, Bottcher M, Hermansen F, Sander M, Nielsen T, Mulvany M . Influence of nitric oxide synthase and adrenergic inhibition on adenosine-induced myocardial hyperemia. Circulation. 2001; 104(19):2305-10. DOI: 10.1161/hc4401.098293. View

Iskandrian A, Heo J, Kong B, Lyons E . Effect of exercise level on the ability of thallium-201 tomographic imaging in detecting coronary artery disease: analysis of 461 patients. J Am Coll Cardiol. 1989; 14(6):1477-86. DOI: 10.1016/0735-1097(89)90385-9. View

Dorbala S, Giugliano R, Logsetty G, Vangala D, Mishra R, Crugnale S . Prognostic value of SPECT myocardial perfusion imaging in patients with elevated cardiac troponin I levels and atypical clinical presentation. J Nucl Cardiol. 2007; 14(1):53-8. DOI: 10.1016/j.nuclcard.2006.07.010. View

10.

De Lorenzo A, Foerster J, Sciammarella M, Suey C, Hayes S, Friedman J . Use of atropine in patients with submaximal heart rate during exercise myocardial perfusion SPECT. J Nucl Cardiol. 2003; 10(1):51-5. DOI: 10.1067/mnc.2003.23. View

11.

Fletcher G, Balady G, Amsterdam E, Chaitman B, Eckel R, Fleg J . Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation. 2001; 104(14):1694-740. DOI: 10.1161/hc3901.095960. View

12.

Duncker D, Bache R . Regulation of coronary blood flow during exercise. Physiol Rev. 2008; 88(3):1009-86. DOI: 10.1152/physrev.00045.2006. View

13.

Al Jaroudi W, Iskandrian A . Regadenoson: a new myocardial stress agent. J Am Coll Cardiol. 2009; 54(13):1123-30. DOI: 10.1016/j.jacc.2009.04.089. View

14.

Thomas G, Thompson R, Miyamoto M, Ip T, Rice D, Milikien D . The RegEx trial: a randomized, double-blind, placebo- and active-controlled pilot study combining regadenoson, a selective A(2A) adenosine agonist, with low-level exercise, in patients undergoing myocardial perfusion imaging. J Nucl Cardiol. 2009; 16(1):63-72. DOI: 10.1007/s12350-008-9001-9. View

15.

Partington S, Lanka V, Hainer J, Blankstein R, Skali H, Forman D . Safety and feasibility of regadenoson use for suboptimal heart rate response during symptom-limited standard Bruce exercise stress test. J Nucl Cardiol. 2012; 19(5):970-8. PMC: 3533237. DOI: 10.1007/s12350-012-9562-5. View

16.

Thomas G, Prill N, Majmundar H, Fabrizi R, Thomas J, Hayashida C . Treadmill exercise during adenosine infusion is safe, results in fewer adverse reactions, and improves myocardial perfusion image quality. J Nucl Cardiol. 2000; 7(5):439-46. DOI: 10.1067/mnc.2000.108030. View

17.

DePuey E . Exercise supplementation of dipyridamole for myocardial perfusion imaging. J Nucl Med. 1991; 32(8):1564-8. View

18.

Sharir T, Slomka P, Hayes S, DiCarli M, Ziffer J, Martin W . Multicenter trial of high-speed versus conventional single-photon emission computed tomography imaging: quantitative results of myocardial perfusion and left ventricular function. J Am Coll Cardiol. 2010; 55(18):1965-74. DOI: 10.1016/j.jacc.2010.01.028. View

19.

Verzijlbergen J, Vermeersch P, Laarman G, Ascoop C . Inadequate exercise leads to suboptimal imaging. Thallium-201 myocardial perfusion imaging after dipyridamole combined with low-level exercise unmasks ischemia in symptomatic patients with non-diagnostic thallium-201 scans who exercise submaximally. J Nucl Med. 1991; 32(11):2071-8. View

20.

Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood J . Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002; 346(11):793-801. DOI: 10.1056/NEJMoa011858. View