Predictive value of myocardial perfusion single-photon emission computed tomography and the impact of renal function...

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.