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Journal of Nuclear Cardiology

, Volume 23, Issue 3, pp 560–569 | Cite as

Prognostic value of heart rate response during regadenoson stress myocardial perfusion imaging in patients with end stage renal disease

  • Wael AlJaroudi
  • Tania Campagnoli
  • Ibtihaj Fughhi
  • Marwan Wassouf
  • Amjad Ali
  • Rami Doukky
Original Article

Abstract

Background

Blunted heart rate response (HRR) to vasodilator stress agents is associated with worse outcomes. There are limited data assessing the effect of impaired HRR to regadenoson among patients with end-stage renal disease (ESRD) undergoing stress myocardial perfusion imaging (MPI).

Methods

We prospectively followed patients with ESRD enrolled in the ASSUAGE and ASSUAGE-CKD trials. HRR was defined as 100*(peak stress heart rate-resting heart rate)/resting heart rate. Study cohort was dichotomized to blunted and normal HRR groups according to an established median HRR value <28% or ≥28%, which were propensity-score matched based on 22 clinical and imaging covariates. The Primary endpoint was all-cause death. The secondary cardiac-specific endpoints included: (1) the composite endpoint of cardiac death or myocardial infarction; (2) the composite endpoint of cardiac death, myocardial infarction, or late (>90 days) coronary revascularization.

Results

There were 303 patients followed for 35 ± 10 months. In the entire cohort, there was a stepwise increase in the rates of death and all secondary endpoints with worsening HRR (P values ≤.001). Blunted HRR (<28%) was associated with increased risk of death (unadjusted hazard ratio 4.10 [1.98-8.46], P < .001) and all secondary endpoints (P ≤ .001). After multivariate adjustment, HRR remained an independent predictor of mortality and secondary endpoints whether used as continuous or dichotomous variable, and added incremental prognostic value for all-cause death (P = .046). Blunted HRR was associated with increased event rate among patients with normal myocardial perfusion (P = .001) and abnormal perfusion (P = .053). In the propensity-matched cohort of 132 patients (66 in each group), blunted HRR was associated with significant increase in all-cause death (21% vs. 5%, HR 5.09 [1.46-17.7], P=.011), and similarly for the secondary endpoints.

Conclusion

Blunted HRR (<28%) to regadenoson is a strong and independent predictor of death and cardiovascular events in patients with ESRD and adds incremental prognostic value.

Keywords

Heart rate response regadenoson myocardial perfusion imaging end-stage renal disease prognosis outcome 

Abbreviations

CR

Coronary revascularization

ESRD

End-stage renal disease

HRR

Heart rate response

MI

Myocardial infarction

MPI

Myocardial perfusion imaging

SDS

Summed difference score

SPECT

Single photon emission computed tomography

SRS

Summed rest score

SSS

Summed stress score

Notes

Disclosure

Rami Doukky serves on the Advisory Board for Astellas Pharma and receives research funding from Astellas Pharma. Other Authors have no conflicts to report.

Funding

None.

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Copyright information

© American Society of Nuclear Cardiology 2015

Authors and Affiliations

  • Wael AlJaroudi
    • 1
  • Tania Campagnoli
    • 2
  • Ibtihaj Fughhi
    • 2
  • Marwan Wassouf
    • 2
  • Amjad Ali
    • 3
  • Rami Doukky
    • 2
    • 4
  1. 1.Division of Cardiovascular MedicineClemenceau Medical CenterBeirutLebanon
  2. 2.Division of CardiologyRush University Medical CenterChicagoUSA
  3. 3.Department of Radiology and Nuclear MedicineRush University Medical CenterChicagoUSA
  4. 4.Division of CardiologyJohn H. Stroger Jr. Hospital of Cook CountyChicagoUSA

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