title: 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: BACKGROUND
  The data existing in the literature regarding the safety of using regadenoson with symptom-limited exercise are limited, which motivated the authors to undertake this randomized study.
  
  
  METHODS
  We offered patients scheduled to undergo vasodilator stress nuclear myocardial perfusion imaging the opportunity to exercise instead. Patients who failed to reach target heart rate (THR) were randomized to (1) receive regadenoson at peak exercise or (2) stop exercise and receive regadenoson at rest. Patients who reached THR received a standard Tc-99m sestamibi injection with no regadenoson.
  
  
  RESULTS
  200 patients were included (66% male, mean age 52.5 ± 13.6). 125 patients (62%) reached THR with exercise alone. All stress protocols were well tolerated, and there were no significant adverse events. There were no statistically significant differences in the extent of perfusion abnormalities, image quality, or rate of referral to cardiac catheterization within 60 days between the groups. In fully adjusted logistic regression models, beta-blocker use and diabetes remained significant univariate predictors of failure to reach THR (OR 0.21, 95% CI 0.1-0.5, P < .0001, OR 0.34, 95% CI 0.2-0.7, P = .004, respectively).
  
  
  CONCLUSIONS
  A protocol combining regadenoson at peak exercise in patients unable to reach THR with exercise is feasible, well-tolerated, and yields comparable imaging results to a standard regadenoson injection at rest. In addition, pharmacologic stress testing may be over-ordered in current clinical practice, as patients referred for such testing were often able to exercise.
authors: Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors: M I
authors: MI
authors: Ross
authors: E
authors: E
authors: Wu
authors: J T
authors: JT
authors: Wilkins
authors: D
authors: D
authors: Gupta
authors: S
authors: S
authors: Shen
authors: D
authors: D
authors: Aulwes
authors: K
authors: K
authors: Montero
authors: T A
authors: TA
authors: Holly
mesh_terms: D058908:Adenosine A2 Receptor Agonists; D000328:Adult; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D010807:Physical Endurance; D005082:Physical Exertion; D011687:Purines / Q000009:adverse effects; D011720:Pyrazoles / Q000009:adverse effects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014665:Vasodilator Agents
chemical_list: D058908:Adenosine A2 Receptor Agonists; D011687:Purines; D011720:Pyrazoles; D014665:Vasodilator Agents; C430916:regadenoson
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