Journal of Nuclear Cardiology

, Volume 18, Issue 6, pp 1086–1094 | Cite as

A blunted heart rate response to regadenoson is an independent prognostic indicator in patients undergoing myocardial perfusion imaging

  • Fadi G. HageEmail author
  • Phillip Dean
  • Fahad Iqbal
  • Jaekyeong Heo
  • Ami E. Iskandrian
Original Article



Regadenoson myocardial perfusion imaging (MPI) is a useful method for risk assessment. We hypothesized that the heart rate response (HRR) to regadenoson carries incremental prognostic information to that derived from perfusion pattern and left ventricular (LV) ejection fraction (EF).

Methods and Results

The study population included 1,156 (60 ± 13 years, 46% women, 40% diabetes mellitus, 53% chronic kidney disease) patients. During a follow-up period of 22 ± 5 months, 103 patients died (9%). Independent determinants of the HRR included age, gender, race, diabetes mellitus, coronary revascularization, LVEF, use of insulin and aldosterone antagonists. Decreasing HRR was associated with stepwise increase in mortality (log-rank P < .0001). In a Cox proportional model for mortality that adjusted for age, gender, diabetes mellitus, renal disease, and MPI findings, HRR in the lowest quartile was independently associated with fivefold increase in mortality compared to the highest quartile [HR 5.2, 95% CI 2.3-12.0, P < .0001]. Patients with a normal HRR had a relatively low annualized total mortality despite the presence of risk factors. The addition of HRR to traditional MPI findings had a net reclassification improvement of 15%, P = .02.


A blunted HRR to regadenoson is an independent predictor of poor outcome, adds incremental value to MPI, and helps in better risk stratification.

Key Words

Regadenoson heart rate response myocardial perfusion imaging risk stratification 


Conflict of interest

Ami Iskandrian has received research funds from Astellas and served as consultant for Gilead.


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Copyright information

© American Society of Nuclear Cardiology 2011

Authors and Affiliations

  • Fadi G. Hage
    • 1
    • 2
    Email author
  • Phillip Dean
    • 3
  • Fahad Iqbal
    • 1
  • Jaekyeong Heo
    • 1
  • Ami E. Iskandrian
    • 1
  1. 1.Division of Cardiovascular DiseaseUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of CardiologyBirmingham Veterans Affairs Medical CenterBirminghamUSA
  3. 3.Department of MedicineUniversity of Alabama at BirminghamBirminghamUSA

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