Safety and feasibility of regadenoson use for suboptimal heart rate response during symptom-limited standard Bruce exercise stress test

Journal of Nuclear Cardiology

Volumn 19, Issue 5, 2012, Pages 970-978

  Partington, Sara L ^a   Lanka, Viswanatha ^a   Hainer, Jon ^a,b   Blankstein, Ron ^a,c   Skali, Hicham ^a,c   Forman, Daniel E ^a,c   Carli, Marcelo F Di ^a,b,c   Dorbala, Sharmila ^b,c  

^a Noninvasive Cardiovascular Imaging Program   (United States)

^b Division of Nuclear Medicine and Molecular Imaging   (United States)

^c HARVARD MEDICAL SCHOOL   (United States)

Author keywords

Exercise stress; Sestamibi; Stress testing; Vasodilator stress

Indexed keywords

AMINOPHYLLINE; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; METHOXY ISOBUTYL ISONITRILE TECHNETIUM TC 99M; REGADENOSON;

ADULT; AGED; ARTICLE; BLOOD PRESSURE MEASUREMENT; BRUCE EXERCISE STRESS TEST; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; CORONARY ARTERY DISEASE; DIZZINESS; DRUG INDUCED HEADACHE; DRUG SAFETY; DRUG TOLERANCE; ELECTROCARDIOGRAPHY MONITORING; EXERCISE ELECTROCARDIOGRAPHY; EXERCISE TEST; EXERCISE TOLERANCE; FEMALE; FLUSHING; FUNCTIONAL STATUS; GASTROINTESTINAL SYMPTOM; HEART HEMODYNAMICS; HEART RATE; HUMAN; HYPEREMIA; HYPERTENSION; MAJOR CLINICAL STUDY; MALE; MYOCARDIAL PERFUSION IMAGING; PHARMACOLOGIC STRESS TESTING; PRIORITY JOURNAL; PROSPECTIVE STUDY; SIDE EFFECT; SINGLE PHOTON EMISSION COMPUTER TOMOGRAPHY; SMOKING; SUBMAXIMAL HEART RATE; SYSTOLIC BLOOD PRESSURE;

ADENOSINE A2 RECEPTOR AGONISTS; AGED; BLOOD PRESSURE; EXERCISE TEST; FEASIBILITY STUDIES; FEMALE; HEART RATE; HUMANS; MALE; MIDDLE AGED; MYOCARDIAL PERFUSION IMAGING; PURINES; PYRAZOLES; TOMOGRAPHY, EMISSION-COMPUTED, SINGLE-PHOTON;

EID: 84868193973     PISSN: 10713581     EISSN: 15326551     Source Type: Journal    
DOI: 10.1007/s12350-012-9562-5     Document Type: Article

References (36)

1. Iskandrian AS, 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;14:1477-86.
2. Steele P, Sklar J, Kirch D, Vogel R, Rhodes CA. Thallium-201 myocardial imaging during maximal and submaximal exercise: Comparison of submaximal exercise with propranolol. Am Heart J. 1983;106:1353-7.
3. Verzijlbergen JF, Vermeersch PH, Laarman GJ, Ascoop CA. 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;32:2071-8.
4. Heller GV, Ahmed I, Tilkemeier PL, Barbour MM, Garber CE. Influence of exercise intensity on the presence, distribution, and size of thallium-201 defects. Am Heart J. 1992;123:909-16.
5. De Lorenzo A, Foerster J, Sciammarella MG, Suey C, Hayes SW, Friedman JD, et al. Use of atropine in patients with submaximal heart rate during exercise myocardial perfusion SPECT. J Nucl Cardiol 2003;10:51-5.
6. Manganelli F, Spadafora M, Varrella P, Peluso G, Sauro R, Di Lorenzo E, et al. Addition of atropine to submaximal exercise stress testing in patients evaluated for suspected ischaemia with SPECT imaging: A randomized, placebo-controlled trial. Eur J Nucl Med Mol Imaging 2011;38:245-51.
7. Al Jaroudi W, Iskandrian AE. Regadenoson: A new myocardial stress agent. J Am Coll Cardiol 2009;54:1123-30.
8. Iskandrian AE, Bateman TM, Belardinelli L, Blackburn B, Cerqueira MD, Hendel RC, et al. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the advance phase 3 multicenter international trial. J Nucl Cardiol 2007;14:645-58.
9. Kwon DH, Cerqueira MD, Young R, Houghtaling P, Lieber E, Menon V, et al. Lessons from regadenoson and low-level treadmill/ regadenoson myocardial perfusion imaging: Initial clinical experience in 1263 patients. J Nucl Cardiol 2010;17:853-7.
10. Thomas GS, Thompson RC, MiyamotoMI, Ip TK, RiceDL,Milikien D, et al. 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;16:63-72.
11. Thompson RC, Al-Amoodi M, Thomas GS, Kennedy KF, Bybee KA, McGhie AI, et al. Combined regadenoson with symptom limited exercise for myocardial perfusion imaging; initial experience and comparison with low-level exercise and no-exercise regadenoson testing [abstract]. Circulation 2010;122:A20926.
12. Ross MI, Holly TA, Gupta D, Shen S, Aulwes D, Montero K, et al. Safety and feasibility of adjunctive regadenoson injection at peak exercise during exercise myocardial perfusion imaging: The both exercise and regadenoson stress test (BERST) trial [abstract]. J Nucl Cardiol 2011;18:773.
13. Parker MW, Barmpouletos D, Swamy Iyah GR, Ardestani A, Mathur S, Ahlberg AW, et al. Safety, tolerability, and imaging quality of regadenoson-as-needed after symptom limited exercise: Results of randomized controlled trial [abstract]. J Nucl Cardiol 2011;18:772-3.
14. Partington SL, Lanka V, Hainer J, Blankstein R, Skali H, Forman DE, et al. Safety and feasibility of regadenoson use at maximal exercise for suboptimal heart rate response to symptom-limited standard Bruce exercise test [abstract]. J Nucl Cardiol 2011;18:763.
15. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, et al. Exercise standards for testing and training: A statement for healthcare professionals from the American Heart Association. Circulation 2001;104:1694-740.
16. Dorbala S, Giugliano RP, Logsetty G, Vangala D, Mishra R, Crugnale S, et al. Prognostic value of SPECT myocardial perfusion imaging in patients with elevated cardiac troponin I levels and atypical clinical presentation. J Nucl Cardiol 2007;14:53-8.
17. Sharir T, Slomka PJ, Hayes SW, DiCarli MF, Ziffer JA, Martin WH, et al. 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;55:1965-74.
18. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539-42.
19. Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, et al. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: Incremental prognostic value and use in risk stratification. Circulation. 1996;93:905-14.
20. Gulati M, Black HR, Shaw LJ, Arnsdorf MF, Merz CN, Lauer MS, et al. The prognostic value of a nomogram for exercise capacity in women. N Engl J Med 2005;353:468-75.
21. Mora S, Redberg RF, Cui Y, Whiteman MK, Flaws JA, Sharrett AR, et al. Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women: A 20-year follow-up of the lipid research clinics prevalence study. JAMA 2003;290:1600-7.
22. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 2002;346:793-801.
23. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med. 1999;341:1351-7.
24. Holly TA, Satran A, Bromet DS, Mieres JH, Frey MJ, Elliott MD, et al. 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;10:291-6.
25. Thomas GS, Prill NV, Majmundar H, Fabrizi RR, Thomas JJ, Hayashida C, et al. Treadmill exercise during adenosine infusion is safe, results in fewer adverse reactions, and improves myocardial perfusion image quality. J Nucl Cardiol 2000;7:439-46.
26. Elliott MD, Holly TA, Leonard SM, Hendel RC. Impact of an abbreviated adenosine protocol incorporating adjunctive treadmill exercise on adverse effects and image quality in patients undergoing stress myocardial perfusion imaging. J Nucl Cardiol 2000;7:584-9.
27. Buus NH, Bottcher M, Hermansen F, Sander M, Nielsen TT, Mulvany MJ. Influence of nitric oxide synthase and adrenergic inhibition on adenosine-induced myocardial hyperemia. Circulation 2001;104:2305-10.
28. Lauer MS, Francis GS, Okin PM, Pashkow FJ, Snader CE, Marwick TH. Impaired chronotropic response to exercise stress testing as a predictor of mortality. JAMA. 1999;281:524-9.
29. Jain M, Nkonde C, Lin BA, Walker A, Wackers FJ. 85% of maximal age-predicted heart rate is not a valid endpoint for exercise treadmill testing. J Nucl Cardiol 2011;18:1026-35.
30. Duncker DJ, Bache RJ. Regulation of coronary blood flow during exercise. Physiol Rev 2008;88:1009-86.
31. Prior JO, Quinones MJ, Hernandez-Pampaloni M, Facta AD, Schindler TH, Sayre JW, et al. Coronary circulatory dysfunction in insulin resistance, impaired glucose tolerance, and type 2 diabetes mellitus. Circulation 2005;111:2291-8.
32. Prior JO, Schindler TH, Facta AD, Hernandez-Pampaloni M, Campisi R, Dahlbom M, et al. Determinants of myocardial blood flow response to cold pressor testing and pharmacologic vasodilation in healthy humans. Eur J Nucl Med Mol Imaging 2007;34:20-7.
33. Schindler TH, Zhang XL, Vincenti G, Mhiri L, Nkoulou R, Just H, et al. Diagnostic value of PET-measured heterogeneity in myocardial blood flows during cold pressor testing for the identification of coronary vasomotor dysfunction. J Nucl Cardiol 2007;14:688-97.
34. Zeiher AM, Drexler H, Wollschlaeger H, Saurbier B, Just H. Coronary vasomotion in response to sympathetic stimulation in humans: Importance of the functional integrity of the endothelium. J Am Coll Cardiol 1989;14:1181-90.
35. Chan SY, Brunken RC, Czernin J, Porenta G, Kuhle W, Krivokapich J, et al. Comparison of maximal myocardial blood flow during adenosine infusion with that of intravenous dipyridamole in normal men. J Am Coll Cardiol 1992;20:979-85.
36. DePuey EG. Exercise supplementation of dipyridamole for myocardial perfusion imaging. J Nucl Med 1991;32:1564-8.