Relation Between Heart Rate Response to Adenosine and Mortality in Patients With End-Stage Renal Disease

This study examined the relation between heart rate (HR) response to adenosine and outcome in patients with end-stage renal disease (ESRD). The usual HR increase during adenosine infusion was caused by direct sympathetic stimulation. It was hypothesized that a blunted HR response, which was probably caused by sympathetic denervation, would be associated with a worse outcome in patients with ESRD. One hundred thirty-nine patients with ESRD being evaluated for renal transplantation who underwent coronary angiography and adenosine gated single-photon emission computed tomographic myocardial perfusion imaging were followed up for all-cause mortality. Percentage of change in HR (%ΔHR) was calculated as [(peak HR during adenosine infusion − HR at rest)/HR at rest] * 100. A control group of 54 patients (normal renal function and no diabetes) was included for comparison of HR responses. Mean age of patients was 54 ± 9 years, 30% were women, and 68% had type-2 diabetes mellitus. %ΔHR was 19.2 ± 18% in patients with ESRD versus 33 ± 25% in the control group (p