Treadmill exercise during adenosine infusion is safe, results in fewer adverse reactions, and improves myocardial perfusion image quality

J Nucl Cardiol. 2000 Sep-Oct;7(5):439-46. doi: 10.1067/mnc.2000.108030.


Background: Combining low-level treadmill exercise with adenosine infusion may result in fewer bradyarrhythmic complications by increasing sympathetic tone and may improve myocardial perfusion image quality by decreasing background activity.

Methods: Patients referred for outpatient pharmacologic stress myocardial perfusion imaging performed simultaneous treadmill exercise (mean 2.2 metabolic equivalents) throughout 6-minute adenosine infusion (adenosine-exercise n = 507). Patients unable to exercise and those with left bundle branch block received adenosine infusion alone (adenosine-nonexercise n = 286). Adverse reaction data were collected on all patients and compared by sex. Background-to-target activity was calculated in a blinded fashion on 200 randomly selected patients.

Results: During the period from April 1996 to December 1998, 507 patients (64%) underwent adenosine-exercise testing, whereas 286 (36%) underwent adenosine-nonexercise testing. Hypotensive and arrhythmic (atrioventricular block, sinus bradycardia, and new onset atrial fibrillation or flutter) adverse reactions occurred less often during adenosine-exercise than during adenosine-nonexercise. Neither death nor myocardial infarction occurred in either group. In the adenosine-exercise group, 2.8% of patients experienced an adverse reaction versus 5.6% of the adenosine-nonexercise group (P = .04). The reduction in adverse reactions occurred in both men and women, although women had significantly more adverse reactions than men (5.7% vs 1.8%, P = .004). Liver/heart and gut/heart ratios were lower in the adenosine-exercise group (1.05+/-0.42 vs. 1.21+/-0.55 , P = .01; 0.61+/-0.21 vs. 0.69+/-0.24, P = .03, respectively).

Conclusions: Compared with adenosine infusion alone, combining low-level treadmill exercise with adenosine in outpatients is safe, better tolerated, and improves image quality. Women were more likely to experience adverse reactions than men.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adenosine / administration & dosage*
  • Adenosine / adverse effects
  • Adult
  • Aged
  • Aged, 80 and over
  • Coronary Circulation*
  • Coronary Disease / diagnostic imaging*
  • Exercise Test* / adverse effects
  • Female
  • Hemodynamics
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Radiopharmaceuticals
  • Retrospective Studies
  • Technetium Tc 99m Sestamibi
  • Thallium Radioisotopes
  • Tomography, Emission-Computed, Single-Photon*


  • Radiopharmaceuticals
  • Thallium Radioisotopes
  • Technetium Tc 99m Sestamibi
  • Adenosine