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.
RCT Entities:
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.
Authors: Francis J Klocke; Michael G Baird; Beverly H Lorell; Timothy M Bateman; Joseph V Messer; Daniel S Berman; Patrick T O'Gara; Blase A Carabello; Richard O Russell; Manuel D Cerqueira; Martin G St John Sutton; Anthony N DeMaria; James E Udelson; J Ward Kennedy; Mario S Verani; Kim Allan Williams; Elliott M Antman; Sidney C Smith; Joseph S Alpert; Gabriel Gregoratos; Jeffrey L Anderson; Loren F Hiratzka; David P Faxon; Sharon Ann Hunt; Valentin Fuster; Alice K Jacobs; Raymond J Gibbons; Richard O Russell Journal: J Am Coll Cardiol Date: 2003-10-01 Impact factor: 24.094
Authors: Deborah H Kwon; Manuel D Cerqueira; Ron Young; Penny Houghtaling; Elizabeth Lieber; Venu Menon; Richard C Brunken; Wael A Jaber Journal: J Nucl Cardiol Date: 2010-04-23 Impact factor: 5.952
Authors: Brian R Leaker; B O'Connor; Trevor T Hansel; Peter J Barnes; Lixen Meng; Vandana S Mathur; Hsiao D Lieu Journal: J Nucl Cardiol Date: 2008-04-14 Impact factor: 5.952
Authors: Gregory S Thomas; Bruce R Tammelin; George L Schiffman; Rudy Marquez; Deborah L Rice; Douglas Milikien; Vandana Mathur Journal: J Nucl Cardiol Date: 2008-04-14 Impact factor: 5.952
Authors: Vasken Dilsizian; Henry Gewirtz; Nicholas Paivanas; Anastasia N Kitsiou; Fadi G Hage; Nathan E Crone; Ronald G Schwartz Journal: J Nucl Cardiol Date: 2015-05-15 Impact factor: 5.952