Heart and Vascular Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
Eur J Nucl Med Mol Imaging. 2013 Feb;40(3):341-8. doi: 10.1007/s00259-012-2296-4. Epub 2012 Dec 4.
The safety of regadenoson (Reg) during low-level exercise testing has been established. However, its administration at peak exercise for patients who do not reach target heart rate (THR) on standard exercise treadmill stress testing (ETT) needs to be established, particularly among patients with known coronary artery disease (CAD) METHODS: From our stress myocardial perfusion imaging (MPI) database, we identified all patients between 2009 and 2012 who underwent standard ETT and received Reg at peak exercise for failure to reach THR. Hemodynamics, side effects, and adverse events were entered prospectively into the database at the time of testing and were subsequently retrieved for analysis.
There were 514 patients, mean age 60 ± 12 years, 34 % female gender, and 51 % with prior CAD. There were 218 (42 %) and 297 (57 %) patients who underwent standard or modified Bruce and Cornell protocols, respectively, and with a mean exercise time of 5.8 ± 2.1 min. The mean percentage of peak heart rate achieved was 71 ± 8 %, and mean maximal metabolic equivalent (MET) was 6.7 ± 1.8. There were 63 (12 %) patients who developed ≥30 mmHg drop in systolic blood pressure (SBP) after 2 min of Reg administration, and 10 (2 %) had SBP <100 mmHg at 2 min and were younger and achieved higher METs; 8 and 2 patients were symptomatic, respectively. The most common side effects reported were shortness of breath (12 %), chest pain/discomfort (13 %), and dizziness (7 %). There was one syncopal event, but no high-degree heart block, cardiac or respiratory arrest. Four patients received aminophylline. Women were more likely to have shortness of breath or gastrointestinal symptoms, while diabetics were less likely to have chest discomfort. There was otherwise no significant difference in adverse events between different groups including those with and without CAD.
Among patients undergoing standard treadmill stress testing for MPI who do not reach THR, the administration of Reg at peak exercise is safe and without major adverse events. Future large prospective studies are warranted to further evaluate the off-label use of Reg in this setting.
已有研究证实，在低水平运动试验中，瑞加德松（Reg）是安全的。但是，对于在标准运动平板压力测试（ETT）中未达到目标心率（THR）的患者，在运动高峰时给予瑞加德松是否安全，仍需要进一步验证，尤其是对于那些已知患有冠状动脉疾病（CAD）的患者。
从我们的应激心肌灌注成像（MPI）数据库中，我们确定了 2009 年至 2012 年间所有在标准 ETT 中接受瑞加德松并在运动高峰时因未达到 THR 而失败的患者。在进行测试时，前瞻性地将血流动力学、副作用和不良事件输入数据库，随后进行检索分析。
共有 514 例患者，平均年龄 60±12 岁，34%为女性，51%有 CAD 病史。218 例（42%）和 297 例（57%）患者分别接受了标准或改良布鲁斯和康奈尔方案，运动时间平均为 5.8±2.1 分钟。达到的最大心率百分比平均为 71±8%，最大代谢当量（MET）平均为 6.7±1.8。有 63 例（12%）患者在瑞加德松给药 2 分钟后收缩压（SBP）下降≥30mmHg，10 例（2%）患者在 2 分钟时 SBP<100mmHg，且这些患者更年轻，达到更高的 MET；8 例和 2 例患者分别出现症状。报告的最常见副作用是呼吸急促（12%）、胸痛/不适（13%）和头晕（7%）。有 1 例晕厥事件，但无高度房室传导阻滞、心脏或呼吸骤停。4 例患者接受了氨茶碱治疗。女性更有可能出现呼吸急促或胃肠道症状，而糖尿病患者则更有可能出现胸痛。在不同组之间，包括有无 CAD 的患者之间，不良事件没有显著差异。
在因 MPI 而行标准跑步机压力测试而未达到 THR 的患者中，在运动高峰时给予瑞加德松是安全的，没有重大不良事件。需要进一步进行大型前瞻性研究，以进一步评估瑞加德松在这种情况下的非适应证使用。
