From the Guidelines
No, a Ventilation/Perfusion (V/Q) scan and a Lexiscan (Regadenoson) stress test should not be performed on the same day, as this approach is not recommended for risk assessment in patients with stable ischemic heart disease (SIHD) according to the 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline [ 1 ].
Key Considerations
- The guideline states that performing more than one stress imaging study or a stress imaging study and a CCTA at the same time is not recommended for risk assessment in patients with SIHD [ 1 ].
- This recommendation is based on a Level of Evidence: C, which suggests that the evidence is not strong, but the guideline still advises against this approach.
- The main concern is that performing multiple tests on the same day may not provide additional benefits and may increase the risk of radiation exposure and other complications.
Clinical Implications
- Clinicians should carefully evaluate the need for each test and consider alternative approaches, such as performing the tests on separate days.
- Patients should be informed about the potential risks and benefits of performing multiple tests on the same day and involved in the decision-making process.
- The nuclear medicine department should be notified in advance if multiple tests are needed, so they can optimize the scheduling and radiotracer doses accordingly.
Radiation Exposure
- The total radiation exposure from both tests in one day is a concern, and patients should be well-hydrated throughout the day to help clear the radiotracers.
- Individual risk-benefit assessment is important, and clinicians should weigh the potential benefits of performing the tests against the potential risks.
From the Research
Ventilation/Perfusion (V/Q) Scan and Lexiscan (Regadenoson) Stress Test
- The provided studies do not directly address whether a Ventilation/Perfusion (V/Q) scan and a Lexiscan (Regadenoson) stress test can be performed on the same day 2, 3, 4, 5, 6.
- However, the studies discuss the individual uses and effectiveness of V/Q scans and Regadenoson stress tests in diagnosing pulmonary embolism and coronary artery disease, respectively.
- Regadenoson is a selective A2A adenosine receptor agonist used for stress myocardial perfusion imaging (MPI) when exercise is contraindicated 3, 4.
- V/Q scans are used for diagnosing pulmonary embolism, and their utilization has declined over time in favor of computed tomography pulmonary angiography (CTPA) 5.
- The feasibility and accuracy of Regadenoson stress real-time myocardial perfusion echocardiography for detecting coronary artery disease have been studied, but not in combination with a V/Q scan on the same day 6.
Key Findings
- Regadenoson stress SPECT-MPI provides independent and incremental prognostic value in predicting adverse cardiac events in patients with left bundle branch block or ventricular paced rhythm 2.
- Regadenoson has a quick onset, short duration, and comparable efficacy to adenosine, but with fewer side effects 4.
- V/Q scanning still has an important role in specific situations, such as in patients with heart failure, diabetes, or renal failure 5.
- The use of Regadenoson stress real-time myocardial perfusion echocardiography with ultrasound contrast agents is a rapid and effective method for detecting coronary artery disease 6.