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

Research output: Contribution to journalArticle


  • Wael Aljaroudi
  • Tania Campagnoli
  • Ibtihaj Fughhi
  • Marwan Wassouf
  • Amjad Ali
  • Rami Doukky

External Institution(s)

  • Rush University
  • Stroger Hospital of Cook County


Original languageEnglish (US)
Pages (from-to)560-569
Number of pages10
JournalJournal of Nuclear Cardiology
Issue number3
StatusPublished - Jun 1 2016


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.

    Research areas

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

Citation formats



Aljaroudi, W, Campagnoli, T, Fughhi, I, Wassouf, M, Ali, A & Doukky, R 2016, 'Prognostic value of heart rate response during regadenoson stress myocardial perfusion imaging in patients with end stage renal disease', Journal of Nuclear Cardiology, vol. 23, no. 3, pp. 560-569.