title: Lessons from regadenoson and low-level treadmill/regadenoson myocardial perfusion imaging: initial clinical experience in 1263 patients.
abstract: BACKGROUND
  Regadenoson is a pharmacologic stress agent, which was recently approved for stress myocardial perfusion imaging (MPI). Aside from the initial protocol-driven studies, clinical experience with this stress agent is limited. Furthermore, low-level treadmill testing in a large population with regadenoson has not previously been evaluated. We describe our experience in the first 6 months of routine inpatient and outpatient clinical use.
  
  
  METHODS
  Between 7/1/08 and 12/04/08, 1263 patients underwent regadenoson stress testing (596 with low-level treadmill, 667 supine). Past medical history, clinical symptoms during stress, and changes in systolic blood pressure were prospectively recorded.
  
  
  RESULTS
  Low-level treadmill testing was well tolerated in our patient population. Shortness of breath, dizziness, palpitations, transient heart block, and nausea were less frequent when patients were able to exercise. In our population, 51% experienced a drop in systolic blood pressure greater than 10 mmHg, with 9% experiencing a decrease in more than 30 mmHg. This decrease in blood pressure was more common in patients who underwent low-level treadmill testing vs those that were supine (56% vs 47%, P-value < 0.001). The frequency of symptoms in our entire population was as follows: chest pain 35%, dizziness/lightheadedness 16%, shortness of breath 27%, headache 1.4%, nausea 2.3%, and palpitations 5%. There were no major hemodynamic or conduction abnormalities. In the 16% of patients, a history of COPD/Asthma Regadenoson MPI was well tolerated. There were no procedural deaths.
  
  
  CONCLUSIONS
  Regadenoson and Regadenoson combined with low level exercise MPI appear to be safe and well tolerated. An asymptomatic fall in systolic blood pressure seems to be more common in patients who undergo low-level treadmill testing.
authors.affiliation: Cleveland Clinic Foundation, 9500 Euclid Ave. J1-5, Cleveland, Ohio 44195, USA.
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Kwon
authors.forename: Manuel D
authors.initials: MD
authors.lastname: Cerqueira
authors.forename: Ron
authors.initials: R
authors.lastname: Young
authors.forename: Penny
authors.initials: P
authors.lastname: Houghtaling
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lieber
authors.forename: Venu
authors.initials: V
authors.lastname: Menon
authors.forename: Richard C
authors.initials: RC
authors.lastname: Brunken
authors.forename: Wael A
authors.initials: WA
authors.lastname: Jaber
mesh_terms: D000328:Adult; D000368:Aged; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011687:Purines; D011720:Pyrazoles; D043705:Receptor, Adenosine A2A / Q000502:physiology*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D011687:Purines; D011720:Pyrazoles; D043705:Receptor, Adenosine A2A; C430916:regadenoson