Influence of body mass index and type of low-level exercise on the side effect profile of regadenoson

Regadenoson, an A_2A adenosine receptor pharmacologic stress agent for radionuclide myocardial perfusion imaging (MPI), is administered as a single, fixed dose. We studied the side effect profile of regadenoson combined with two types of low-level exercise, according to body mass index (BMI).

Three hundred and fifty-six patients (46.1% men, mean age 67.7±10.7 years, range 31-90 years) underwent regadenoson stress testing combined with low-level exercise. Subjects were classified according to BMI as normal, overweight, or obese, and the type of low-level exercise performed as walking on the treadmill (TE group, n=190) or forcefully swinging legs while sitting (SS group, n=166). Patients' demographics, medical history, clinical symptoms during stress, changes in ECG, oxygen saturation (SatO₂), systolic blood pressure (SBP), and heart rate (HR) were evaluated.

Groups were comparable (p=ns) with regard to cardiovascular risks factors. The incidence of side effects was similar across BMI (p=ns), although the TE patients showed improved profiles over those with SS exercise, with a significantly lower incidence of flushing, dizziness and nausea/gastrointestinal discomfort (12.9% vs. 28.4%; 19.9% vs. 33.4%; 11.4% vs. 19.2%, respectively; all p<0.05). Regarding the hemodynamic response, we did not observe significant changes in SBP and HR after regadenoson administration across BMI categories. Comparing the TE and SS groups, no significant changes were observed in SBP, but there was a higher increase in HR in the TE group (p<0.05).

Regadenoson in combination with low-level exercise is safe and well tolerated over a wide range of BMI, with TE exercise showing a better side effect profile than SS.