Prognostic value of myocardial perfusion imaging and coronary artery calcium measurements in patients with end-stage renal disease.

Abstract

OBJECTIVE:

Coronary artery disease (CAD) is highly prevalent in patients with end-stage renal disease (ESRD), owing to clustering of traditional and uremic-specific risk factors. However, in this population asymptomatic course of CAD is common and it has been reported that myocardial perfusion imaging (MPI) with single-photon emission tomography (SPET) has lower sensitivity. In the current study, we assessed the value of MPI gated-SPET and its combination with coronary artery calcium (CAC) score measurements in risk stratification of ESRD patients.

MATERIALS AND METHODS:

MPI gated-SPET was performed with dual-headed SPET camera and CAC score measured by multi-detector computed tomography (MDCT) system.There were tested 77 ESRD individuals. During the follow-up study, cardiac events (CE) defined as cardiac death or nonfatal myocardial infarction (MI) or the necessity for coronary revascularization were recorded. Univariate and stepwise multivariable Cox proportional hazards-models were used to identify the predictors of CE.

RESULTS:

Eighteen CE were recorded during the follow-up. They were significantly associated with higher summed stress scores on MPI, higher percentage of ischaemic myocardium, higher occurrence of defects in multiple territories and higher CAC score (all with P<0.05). Univariate Cox proportional hazard-models showed that severe perfusion abnormalities as well as CAC score ≥1000 were significantly associated with cardiac events (P<0.0001, P=0.0056). In stepwise Cox proportional hazards-models considering age, gender, history of diabetes mellitus, post-stress left ventricular stunning, the degree of perfusion abnormality and CAC score, only severe perfusion abnormalities and CAC score ≥1000 were independent predictors of CE. There was no CE in patients with normal perfusion, normal function and zero CAC score.

CONCLUSION:

This study suggests that combined evaluation of MPI and CAC can predict the outcome in ESRD individuals, while severe perfusion abnormality on gated-SPET and high CAC score ≥1000 are predictors of future cardiac events.

• Authors: Martin Havel, Milan Kaminek, Iva Metelkova, Miroslava Budikova, Lenka Henzlova, Pavel Koranda, Josef Zadražil, Vladimir Kincl
• Journal: Hellenic journal of nuclear medicine (Hell J Nucl Med) 2015 Sep-Dec Vol. 18 Issue 3 Pg. 199-206 ISSN: 1790-5427 [Print] Greece
• PMID: 26574691 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Calcinosis (diagnostic imaging, mortality)
• Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography (statistics & numerical data)
• Comorbidity
• Coronary Artery Disease (diagnostic imaging, mortality)
• Czech Republic (epidemiology)
• Female
• Humans
• Kidney Failure, Chronic (diagnostic imaging, etiology, mortality)
• Male
• Middle Aged
• Myocardial Perfusion Imaging (statistics & numerical data)
• Prevalence
• Prognosis
• Reproducibility of Results
• Risk Factors
• Sensitivity and Specificity
• Survival Rate