BACKGROUND: 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. CONCLUSION: A blunted HRR to regadenoson is an independent predictor of poor outcome, adds incremental value to MPI, and helps in better risk stratification.
BACKGROUND: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. CONCLUSION: A blunted HRR to regadenoson is an independent predictor of poor outcome, adds incremental value to MPI, and helps in better risk stratification.
Authors: Aiden Abidov; Rory Hachamovitch; Sean W Hayes; Chee Keong Ng; Ishac Cohen; John D Friedman; Guido Germano; Daniel S Berman Journal: Circulation Date: 2003-06-09 Impact factor: 29.690
Authors: Wael AlJaroudi; M Chadi Alraies; Venu Menon; Richard C Brunken; Manuel D Cerqueira; Wael A Jaber Journal: J Nucl Cardiol Date: 2012-06-13 Impact factor: 5.952
Authors: Christopher W Ives; Wael A AlJaroudi; Vineeta Kumar; Ayman Farag; Dana V Rizk; Suzanne Oparil; Ami E Iskandrian; Fadi G Hage Journal: Eur J Nucl Med Mol Imaging Date: 2018-06-07 Impact factor: 9.236
Authors: Catherine Gebhard; Monika Maredziak; Michael Messerli; Ronny R Buechel; Fay Lin; Heidi Gransar; Stephan Achenbach; Mouaz H Al-Mallah; Daniele Andreini; Jeroen J Bax; Daniel S Berman; Matthew J Budoff; Filippo Cademartiri; Tracy Q Callister; Hyuk-Jae Chang; Kavitha Chinnaiyan; Benjamin J W Chow; Ricardo C Cury; Augustin DeLago; Gudrun Feuchtner; Martin Hadamitzky; Joerg Hausleiter; Yong-Jin Kim; Jonathon Leipsic; Erica Maffei; Hugo Marques; Pedro de Araújo Gonçalves; Gianluca Pontone; Gilbert L Raff; Ronen Rubinshtein; Leslee J Shaw; Todd C Villines; Yao Lu; Erica C Jones; Jessica M Peña; James K Min; Philipp A Kaufmann Journal: Eur Heart J Cardiovasc Imaging Date: 2020-04-01 Impact factor: 6.875
Authors: Ahmed Haider; Susan Bengs; Monika Maredziak; Michael Messerli; Michael Fiechter; Andreas A Giannopoulos; Valerie Treyer; Moritz Schwyzer; Christel Hermann Kamani; Dimitri Patriki; Elia von Felten; Dominik C Benz; Tobias A Fuchs; Christoph Gräni; Aju P Pazhenkottil; Philipp A Kaufmann; Ronny R Buechel; Catherine Gebhard Journal: Eur J Nucl Med Mol Imaging Date: 2019-01-16 Impact factor: 9.236