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Regadenoson Combined With Symptom-Limited Exercise in Patients Undergoing Myocardial Perfusion Imaging

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ClinicalTrials.gov Identifier: NCT01021618
Recruitment Status : Completed
First Posted : November 30, 2009
Results First Posted : December 28, 2012
Last Update Posted : March 21, 2013
Astellas Pharma Inc
Information provided by (Responsible Party):
Hartford Hospital

November 25, 2009
November 30, 2009
October 23, 2012
December 28, 2012
March 21, 2013
January 2010
March 2012   (Final data collection date for primary outcome measure)
Number of Participants With Major Adverse Events or Side Effects Graded "Severe" on Symptom Questionnaire [ Time Frame: 24 hours ]
Number of participants with any side effect (flushing, shortness of breath, headache, chest discomfort, dizziness, nausea, or abdominal pain) requiring specific treatment or graded as "severe" by the patient; or any death, myocardial infarction, or unplanned hospitalization. Note that 2 patients allocated to exercise-vasodilator stress did not complete symptom questionnaires and are therefore excluded from analysis.
Major adverse events [ Time Frame: 24 hours ]
Complete list of historical versions of study NCT01021618 on ClinicalTrials.gov Archive Site
Myocardial Perfusion Image Quality [ Time Frame: 0 hours ]
Single photon emission computed tomography myocardial perfusion acquisition and image processing was performed in accordance with American Society of Nuclear Cardiology guidelines. All images were interpreted by consensus read of three investigators blinded to stress test protocol and results. Overall perfusion and gated image quality were described as excellent (no artifacts interfering with myocardial perfusion interpretation), good, fair, or poor (artifact requiring reprocessing or repeat imaging of the patient to allow for diagnostic interpretation).
Myocardial Perfusion Image Quality [ Time Frame: 0 hours ]
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Regadenoson Combined With Symptom-Limited Exercise in Patients Undergoing Myocardial Perfusion Imaging
The Ex-Lex Trial: A Randomized Trial Combining Regadenoson With Symptom-Limited Exercise in Patients Undergoing Myocardial Perfusion Imaging
Not infrequently, a physician is faced with uncertainty regarding the ability of a patient to perform adequate exercise in the noninvasive evaluation of known or suspected coronary artery disease (CAD) by the use of radionuclide stress myocardial perfusion imaging. In selected patients, protocols that combine exercise (either low-level or symptom-limited) with vasodilator stress agents have been found to be safe and effective in both identification of the presence and severity of CAD as well as risk stratification for adverse cardiac outcome. However, currently utilized combined stress protocols have drawbacks. Further refinement of combined stress protocols would potentially lead to more appropriate stress protocol selection for patients while enhancing laboratory efficiency. The purpose of this prospective, randomized study will be to evaluate the relative merits of combining regadenoson with symptom-limited exercise in patients clinically-referred for vasodilator-exercise stress myocardial perfusion imaging for the assessment of known or suspected CAD. It is hypothesized that combining regadenoson with symptom-limited exercise is a safe and feasible stress testing modality which is non-inferior to that which combines symptom-limited exercise with dipyridamole.
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Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
  • Coronary Artery Disease
  • Myocardial Ischemia
  • Drug: Regadenoson
    Regadenoson (0.4mg/5 mL) injection during symptom-limited exercise with technetium-99m SPECT myocardial perfusion imaging
    Other Names:
    • Lexiscan
    • Exercise-lexiscan stress test
  • Other: Symptom-limited exercise
    Dipyridamole (0.56 mg/kg) over 4 minutes followed by symptom-limited exercise with technetium-99m SPECT myocardial perfusion imaging
    Other Names:
    • Persantine
    • Persantine-exercise stress test
  • Active Comparator: Vasodilator-exercise stress
    Four-minute infusion of dipyridamole (0.56 mg/kg) followed by symptom-limited exercise; injection of technetium-99m labeled radiopharmaceutical at peak hyperemia or peak exercise followed by SPECT myocardial perfusion imaging
    Intervention: Other: Symptom-limited exercise
  • Experimental: Exercise-vasodilator stress
    Symptom-limited exercise followed by a bolus intravenous injection of regadenoson (0.4 mg/5 mL) in patients failing to achieve a standard clinical endpoint; injection of technetium-99m labeled radiopharmaceutical 15 seconds after administration of regadenoson (or at peak exercise if regadenoson not administered) followed by SPECT myocardial perfusion imaging.
    Intervention: Drug: Regadenoson

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
March 2012
March 2012   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Males and non-pregnant, non-nursing females clinically referred for vasodilator stress myocardial perfusion imaging with the addition of exercise
  • Age >=30 years

Exclusion Criteria:

  • Extremely limited functional capacity
  • Age <30 years
  • Unable or unwilling to provide informed consent
  • Pregnant or nursing females
  • Current use of methylxanthines within 12 hours of testing
  • Current use of dipyridamole or aminophylline within 48 hours of testing
  • Uncontrolled hypertension (>200 mmHg systolic/>120 mmHg diastolic)
  • Known hypertrophic cardiomyopathy with obstruction or severe aortic stenosis
  • Decompensated congestive heart failure
  • History of sick sinus syndrome or > first degree atrioventricular block in the absence of a functioning pacemaker
  • Asthma or other bronchospastic reactive airway disease
  • History of percutaneous coronary intervention or coronary artery bypass grafting, or documented history of acute myocardial infarction or unstable angina within one week of testing
  • Patients at risk for hypotensive reaction to regadenoson
Sexes Eligible for Study: All
30 Years and older   (Adult, Senior)
Contact information is only displayed when the study is recruiting subjects
United States
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Hartford Hospital
Hartford Hospital
Astellas Pharma Inc
Principal Investigator: Gary V Heller, MD, PhD Hartford Hospital
Hartford Hospital
March 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP