title: Prognostic value of heart rate response during regadenoson stress myocardial perfusion imaging in patients with end stage renal disease.
abstract: 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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors: Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon.
authors: Wael
authors: W
authors: AlJaroudi
authors: Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
authors: Tania
authors: T
authors: Campagnoli
authors: Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
authors: Ibtihaj
authors: I
authors: Fughhi
authors: Division of Cardiology, Rush University Medical Center, Chicago, IL, USA.
authors: Marwan
authors: M
authors: Wassouf
authors: Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA.
authors: Amjad
authors: A
authors: Ali
authors: Division of Cardiology, Rush University Medical Center, Chicago, IL, USA. rami_doukky@rush.edu.|Division of Cardiology, John H. Stroger Jr. Hospital of Cook County, 1901 W. Harrison St., Suite # 3620, 60612, Chicago, IL, USA. rami_doukky@rush.edu.
authors: Rami
authors: R
authors: Doukky
mesh_terms: D015984:Causality; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004311:Double-Blind Method; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D000070276:Heart Rate Determination / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality*; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D011687:Purines; D011720:Pyrazoles; D012307:Risk Factors; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents
chemical_list: D011687:Purines; D011720:Pyrazoles; D014665:Vasodilator Agents; C430916:regadenoson
keywords: Heart rate response; end-stage renal disease; myocardial perfusion imaging; outcome; prognosis; regadenoson