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Updated: Jun 18, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Incremental prognostic value of myocardial perfusion imaging in patients referred to stress single-photon emission
Mouaz H Al-Mallah1, Rory Hachamovitch, Sharmila Dorbala
1Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Insights
Single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) helps identify higher mortality risk in patients with impaired kidney function. Abnormal SPECT-MPI results indicate increased risk of death across all stages of renal function.
Area of Science:
- Cardiology
- Nephrology
- Nuclear Medicine
Background:
- Coronary artery disease (CAD) is a leading cause of death in patients with chronic kidney disease.
- Assessing cardiovascular risk in patients with renal impairment is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the prognostic value of single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in patients with impaired renal function.
- To determine if SPECT-MPI can identify patients with higher risk of mortality among those with reduced kidney function.
Main Methods:
- A cohort of 7348 patients referred for SPECT-MPI was analyzed.
- Renal function was assessed using estimated glomerular filtration rate (eGFR).
- Patients were followed for all-cause mortality, with outcomes analyzed using Cox proportional hazards models.
Main Results:
- Patients with lower eGFR were older and had more risk factors.
- Mortality risk increased with declining kidney function.
- Abnormal SPECT-MPI findings were associated with a significantly higher risk of death, independent of renal function.
Conclusions:
- SPECT-MPI provides valuable prognostic information in patients with impaired renal function.
- The imaging technique aids in identifying individuals at elevated risk of mortality across a spectrum of kidney function.
Background:
Coronary artery disease is the main cause of mortality and morbidity in patients with impaired renal function. The aim of this study was to evaluate the prognostic implications of single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in patients with impaired renal function.
Methods And Results:
We included 7348 consecutive patients (mean age, 64+/-13 years; 51% men) referred for SPECT-MPI between March 2002 and October 2006. Renal function was estimated using the estimated glomerular filtration rate formula. Patients were followed up for the incidence of all-cause mortality. Patients with decreased glomerular filtration rate were more often older, with higher prevalence of conventional risk factors (P<0.001). After a median follow-up of 2.6 years (25th to 75th percentiles, 1.5 to 3.7), 693 (9.4%) patients died. The risk of death increased with worsening kidney function. At each stage of impaired renal function, patients with abnormal SPECT-MPI had increased hazard of adverse events (P<0.0001). Using Cox proportional hazards analysis, the magnitude of total perfusion deficit and ischemia on MPI were associated with worse outcome after adjusting for confounding variables including glomerular filtration rate and ejection fraction.
Conclusions:
SPECT-MPI adds modest incremental prognostic information to identify patients at higher relative risk of death across a wide spectrum of renal function.
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