Evaluating the use of pharmacological stress agents during single-photon emission computed tomography myocardial perfusion imaging tests after inadequate exercise stress test

Abstract

Background Past clinical trial findings suggest that the availability of regadenoson in a nuclear imaging center may affect real-world center practices related to the transition of patients from an inadequate exercise stress test (EST) to a pharmacological stress agent (PSA). Methods and Results This was a cross-sectional study using one-on-one telephone interviews with nuclear imaging center staff to facilitate survey development, followed by an online survey to evaluate patterns and processes around use of PSAs during single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in patients with inadequate ESTs. Of the 50 participants, 35 (70%) used only regadenoson, 3 (6%) only adenosine, 3 (6%) regadenoson and adenosine, 7 (14%) regadenoson and dipyridamole, and 2 (4%) all 3 agents for converting patients from an inadequate EST to a PSA. Nearly all centers (94%) used protocols to guide conversions. Of 12 centers using > 1 PSA, 11 reported regadenoson to be the most preferred PSA. Total staff time required from PSA transition to post-test monitoring was shortest for regadenoson. Conclusions Compared to adenosine and dipyridamole, regadenoson is preferred by nuclear imaging center staff and associated with operational efficiencies after inadequate EST in real-world practice SPECT-MPI.

Safety and tolerability of regadenoson compared with dipyridamole in myocardial perfusion imaging in patients scheduled to undergo medium to high-risk noncardiac surgery: a randomized controlled study

“…On the other hand, dipyridamole while having a similar safety profile with regadenoson, it was associated with a longer duration of adverse reactions. Furthermore, several studies have demonstrated regadenoson’s superiority in the presence of patients with asthma [17] or chronic obstructive pulmonary disease [18] or whenever inadequate physical stress needs to be converted to pharmacologic stress [19,20].…”

Pharmacological stress myocardial perfusion imaging after an inadequate exercise stress test

“…Use of regadenoson allows nuclear labs to use it as an add-on agent in patients who undergo exercise stress test but fail to achieve the target heart rate or METs. The paper by Yang et al 5 in this issue of the journal demonstrates that regadenoson was the most commonly used agent when patients with inadequate exercise stress test were converted to pharmacological stress test. The use and administration of regadenoson was not considered complex by the nuclear imaging centers' staff and most patients were successfully converted to pharmacologic stress test on the same day in the same session.…”