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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Predictive value of myocardial perfusion single-photon emission computed tomography and the impact of renal function
Abdul Hakeem1, Sabha Bhatti, Kathryn Sullivan Dillie
1Division of Cardiovascular Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45257-0542, USA. ahakeem@gmail.com
Insights
Chronic kidney disease (CKD) worsens cardiovascular outcomes. Myocardial perfusion imaging (MPS) and CKD are independent predictors of cardiac death, with CKD patients having a poorer prognosis even with normal scans.
Area of Science:
- Cardiology
- Nephrology
- Nuclear Medicine
Background:
- Patients with chronic kidney disease (CKD) experience higher rates of adverse cardiovascular outcomes.
- The prognostic value of myocardial perfusion single-photon emission CT (MPS) in patients with impaired renal function is not well-established.
- The impact of CKD on predicting cardiac death in patients undergoing MPS requires further investigation.
Purpose of the Study:
- To evaluate the prognostic utility of MPS in patients with varying degrees of renal dysfunction.
- To determine the impact of CKD on cardiac death prediction in patients undergoing MPS.
- To assess the combined predictive value of MPS and renal function for cardiac events.
Main Methods:
- A cohort of 1652 patients undergoing stress MPS was followed for cardiac death.
- Renal function was assessed using the Modified Diet in Renal Disease (MDRD) equation, with CKD defined as an estimated glomerular filtration rate <60 mL/min/1.73 m².
- Multivariate Cox proportional hazards models were used to identify independent predictors of cardiac death.
Main Results:
- 36% of patients had CKD. Cardiac death rates increased with worsening MPS perfusion defects across all renal function levels.
- Both MPS perfusion defects (HR 1.90) and CKD (HR 1.96) were independent predictors of cardiac death.
- Patients with normal MPS and CKD had significantly higher cardiac death rates than those without CKD and normal MPS (2.7% vs. 0.8%).
Conclusions:
- MPS effectively stratifies risk across the spectrum of renal function.
- Renal dysfunction is an independent predictor of cardiac death in patients undergoing MPS.
- Combining MPS and renal function assessment provides additive value for risk stratification in patients with suspected coronary artery disease, highlighting a worse prognosis for CKD patients even with normal MPS findings.
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 2.15+/-0.8 years. MPS defects were defined with a summed stress score (normal summed stress score <4, abnormal summed stress score>or=4). Ischemia was defined as a summed stress score >or=4 plus a summed difference score >or=2, and scar was defined as a summed difference score <2 plus a summed stress score >or=4. Renal function was calculated with the Modified Diet in Renal Disease equation. CKD (estimated glomerular filtration rate <60 mL . min(-1) . 1.73 m(-2)) 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%, P=0.001). 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 chi(2) 207.5 versus 169.3, P<0.0001).
Conclusions:
MPS provides effective risk stratification across the entire spectrum of renal function. Renal dysfunction is also an important independent predictor of cardiac death in patients undergoing MPS. Renal function and MPS have additive value in risk stratisfying patients with suspected coronary artery disease. Patients with CKD appear to have a relatively less benign prognosis than those without CKD, even in the presence of a normal scan.
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