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Journal of Nuclear Cardiology

, Volume 24, Issue 5, pp 1666–1671 | Cite as

Impact of integrating heart rate response with perfusion imaging on the prognostic value of regadenoson SPECT myocardial perfusion imaging in patients with end-stage renal disease

  • Javier Gomez
  • Ibtihaj Fughhi
  • Tania Campagnoli
  • Amjad Ali
  • Rami Doukky
Brief Report

Abstract

Background

We investigated whether integrating heart rate response (HRR) to regadenoson with myocardial perfusion imaging (MPI) analysis can enhance risk prediction in end-stage renal disease (ESRD) patients.

Methods and Results

We prospectively followed 303 ESRD patients after regadenoson stress MPI for a mean of 35 months. Normal HRR to regadenoson was defined as ≥28% increase from baseline. Normal MPI was defined as a summed stress score ≤3 and left ventricular ejection fraction ≥50%. The study cohort was divided in four groups based on various combinations of normal/abnormal HRR and MPI. There was a step-wise increase in the risk of primary endpoint of all-cause death and the composite secondary endpoint of cardiac death or myocardial infarction; patients with Normal MPI/Normal HRR had the lowest event rates and those with Abnormal MPI/Abnormal HRR had the highest, whereas subjects with Abnormal MPI/Normal HRR and Normal MPI/Abnormal HRR had intermediate event rates. This pattern was maintained after adjusting for important clinical covariates.

Conclusion

In ESRD patients, integrating HRR to vasodilator stress with MPI interpretation improves risk stratification. Normal HRR/Normal MPI identify truly low-risk group, whereas abnormal MPI or abnormal HRR portrays elevated risk.

Keywords

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

Abbreviations

ESRD

End-stage renal disease

HRR

Heart rate response

MI

Myocardial infarction

MPI

Myocardial perfusion imaging

SPECT

Single-photon emission computed tomography

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.

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Copyright information

© American Society of Nuclear Cardiology 2016

Authors and Affiliations

  • Javier Gomez
    • 1
  • Ibtihaj Fughhi
    • 2
  • Tania Campagnoli
    • 3
  • Amjad Ali
    • 4
  • Rami Doukky
    • 1
    • 2
  1. 1.Division of CardiologyJohn H. Stroger, Jr. Hospital of Cook CountyChicagoUSA
  2. 2.Division of CardiologyRush University Medical CenterChicagoUSA
  3. 3.Department of MedicineRush University Medical CenterChicagoUSA
  4. 4.Department of Radiology and Nuclear MedicineRush University Medical CenterChicagoUSA

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