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A strategy of symptom-limited exercise with regadenoson-as-needed for stress myocardial perfusion imaging: A randomized controlled trial

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Ambulatory patients with uncertain functional capacity may benefit from combined exercise and vasodilator stress protocols for myocardial perfusion imaging (MPI). The safety and MPI image quality with regadenoson administered during symptom-limited exercise have not been prospectively evaluated.

Methods and Results

A total of 140 patients (mean age 61 years, 48% female) referred for exercise with vasodilator stress MPI were randomized 2:1 to a strategy of exercise with regadenoson-as-necessary (Ex-Reg, n = 96) or dipyridamole with exercise (Dip-Ex, n = 44) after Duke Activity Status Index (DASI) scoring (median score 28 vs 24, P = .09). Ex-Reg subjects commenced treadmill exercise and regadenoson was administered only if the subject was unable to reach standard endpoints. Dip-Ex subjects received dipyridamole prior to symptom-limited exercise. Hemodynamics were recorded throughout. Subjects completed symptom questionnaires and MPI image quality was assessed by blinded read. Ex-Reg subjects were more likely to achieve ≥85% age-predicted maximum heart rate than Dip-Ex subjects (57% vs 32%, P < .01). Only 50% of subjects meeting inclusion criteria and randomized to Ex-Reg required regadenoson and none had symptomatic hemodynamic changes. Severe side effects or adverse events occurred in 16% of Ex-Reg and 24% of Dip-Ex subjects (P = .12). MPI image quality was “good” or “excellent” in 88% of Ex-Reg subjects and 86% of Dip-Ex subjects (P = .33).

Conclusion

A strategy of exercise with regadenoson-as-needed for MPI offers similar safety and side effect profile with similar image quality compared to dipyridamole with exercise, with reduced pharmaceutical use.

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Disclosure

This project was supported by an investigator-initiated research grant from Astellas Pharma US, Deerfield IL.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, USA

    Matthew W. Parker MD, Donna Chelle Morales DO, Hanna B. Slim MD, Shishir Mathur MD, Afrooz Ardestani MD, Dimitrios Barmpouletos MD, Geeta Swamy Iyah MD & Gary V. Heller MD, PhD

  2. Department of Nuclear Medicine, University of Connecticut School of Medicine, Farmington, CT, USA

    Gary V. Heller MD, PhD

  3. Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA

    Matthew W. Parker MD, Donna Chelle Morales DO, Hanna B. Slim MD, Alan W. Ahlberg MA, Deborah M. Katten RN, MPH, Giselle Cyr RN, Shishir Mathur MD, Afrooz Ardestani MD, Dimitrios Barmpouletos MD, Geeta Swamy Iyah MD & Steven M. Borer DO

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  1. Matthew W. Parker MD
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  2. Donna Chelle Morales DO
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  12. Gary V. Heller MD, PhD
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Correspondence to Matthew W. Parker MD.

Additional information

See related editorial, doi:10.1007/s12350-012-9643-5

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Parker, M.W., Morales, D.C., Slim, H.B. et al. A strategy of symptom-limited exercise with regadenoson-as-needed for stress myocardial perfusion imaging: A randomized controlled trial. J. Nucl. Cardiol. 20, 185–196 (2013). https://doi.org/10.1007/s12350-012-9641-7

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