Predictive Value of Myocardial Perfusion Single-Photon Emission Computed Tomography and the Impact of Renal Function on Cardiac Death

Abstract

Background-Patients with chronic kidney disease (CKD) have worse cardiovascular outcomes than those without CKD. The prognostic utility of myocardial perfusion single-photon emission CT (MPS) in patients with varying degrees of renal dysfunction and the impact of CKD on cardiac death prediction in patients undergoing MPS have not been investigated. Methods and Results-We followed up 1652 consecutive patients who underwent stress MPS (32% exercise, 95% gated) for cardiac death for a mean of 2.15Ϯ0.8 years. MPS defects were defined with a summed stress score (normal summed stress score Ͻ4, abnormal summed stress scoreՆ4). Ischemia was defined as a summed stress score Ն4 plus a summed difference score Ն2, and scar was defined as a summed difference score Ͻ2 plus a summed stress score Ն4. Renal function was calculated with the Modified Diet in Renal Disease equation. CKD (estimated glomerular filtration rate Ͻ60 mL · min Ϫ1 · 1.73 m Ϫ2 ) was present in 36%. Cardiac death increased with worsening levels of perfusion defects across the entire spectrum of renal function. Presence of ischemia was independently predictive of cardiac death, all-cause mortality, and nonfatal myocardial infarction. Patients with normal MPS and CKD had higher unadjusted cardiac death event rates than those with no CKD and normal MPS (2.7% versus 0.8%, Pϭ0.001). Multivariate Cox proportional hazards models revealed that both perfusion defects (hazard ratio 1.90, 95% CI 1.47 to 2.46) and CKD (hazard ratio 1.96, 95% CI 1.29 to 2.95) were independent predictors of cardiac death after accounting for risk factors, left ventricular dysfunction, pharmacological stress, and symptom status. Both MPS and CKD had incremental power for cardiac death prediction over baseline risk factors and left ventricular dysfunction (global 2 207.5 versus 169.3, PϽ0.0001). Conclusions-MPS

Prognostic study of cardiac events in Japanese patients with chronic kidney disease using ECG-gated myocardial Perfusion imaging: Final 3-year report of the J-ACCESS 3 study

“…Our previous studies and those of others have suggested that MPI can help predict outcomes among patients with suspected or extant CAD and those with CKD. [10][11][12][13] Although the incidence and severity of CVD are increased in patients with CKD, 1,3 routine screening has not yet been implemented in clinical practice. In addition, optional time-frame for screening for CVD among patients with CKD has not been established.…”

“…19 The MPI defect score was relatively lower than those previously reported. [10][11][12][13] Since we excluded patients with CKD who had CAD, such a small defect might impact cardiac events in patients without such a diagnosis.…”

“…Our previous and other studies suggested that MPI could predict the outcomes of patients with suspected or extant CAD and those with CKD. [10][11][12][13] However, the study by Hakeem et al is limited because it proceeded at a single center and by the nature of the study population. 13 Therefore, we started a multicenter prospective cohort study called J-ACCESS 3, to determine the ability of MPI to diagnose CAD and predict the outcomes of patients with CKD who are not definitively diagnosed with CAD.…”

“…[10][11][12][13] However, the study by Hakeem et al is limited because it proceeded at a single center and by the nature of the study population. 13 Therefore, we started a multicenter prospective cohort study called J-ACCESS 3, to determine the ability of MPI to diagnose CAD and predict the outcomes of patients with CKD who are not definitively diagnosed with CAD. The study aimed to clarify whether MPI can predict cardiac events and to determine whether renal dysfunction combined with MPI abnormalities provides additional prognostic information to conventional markers.…”

Heart rate response during vasodilator stress myocardial perfusion imaging: Mechanisms and implications

“…1 In high-risk populations, as in those with diabetes mellitus (DM) or chronic kidney disease, MPI has been shown to be a powerful predictor of risk, but nevertheless, patients with normal myocardial perfusion are at higher risk than those without DM or chronic kidney disease. 2,3 Thus, there continues to be a need to extract more useful prognostic data from stress MPI especially in high-risk populations.…”