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Prognostic value of regadenoson myocardial single-photon emission computed tomography in patients with different
Sabha Bhatti1, Abdul Hakeem2, Sunitha Dhanalakota3
1Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences and Central Arkansas VA Medical Center, Little Rock, AR, USA Department of Internal Medicine, Heart and Vascular Institute, Henry Ford Hospital, 2799 West Grand Blvd, K-14, Detroit, MI 48202, USA.
Insights
Regadenoson stress imaging (REG-SPECT) effectively predicts cardiac events in patients with chronic kidney disease (CKD). Reduced kidney function (GFR <60) independently predicts major adverse cardiac events (MACE) in patients undergoing REG-SPECT.
Area of Science:
- Cardiology
- Nephrology
- Nuclear Medicine
Background:
- Patients with chronic kidney disease (CKD) exhibit poorer cardiovascular outcomes.
- The prognostic implications of regadenoson (REG) stress imaging in individuals with varying kidney function remain unclear.
- The impact of kidney dysfunction on cardiac outcomes during REG-SPECT requires definition.
Purpose of the Study:
- To assess the prognostic value of regadenoson stress imaging (REG-SPECT) across different levels of kidney function.
- To determine if reduced kidney function influences cardiac outcomes in patients undergoing REG-SPECT.
Main Methods:
- A cohort of 1107 patients undergoing REG-SPECT was followed for 1.8 years.
- Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m².
- Kaplan-Meier survival analysis was used to evaluate major adverse cardiac events (MACE).
Main Results:
- Patients with GFR <60 had a higher prevalence of cardiac risk factors and coronary artery disease.
- Lower GFR (<60) was associated with increased risks of congestive heart failure, cardiac death, all-cause death, and MACE.
- Reduced GFR (<60) independently predicted MACE (HR 1.49), and transient ischemic dilation (TID) predicted MACE (HR 5.06).
Conclusions:
- Renal function is a significant predictor of risk in patients undergoing REG-SPECT.
- Regadenoson stress imaging offers reliable prognostication across the full spectrum of renal function.
Aims:
Patients with chronic kidney disease (CKD) have worse cardiovascular outcomes. The prognostic value of the new pharmacological stressor regadenoson (REG) in patients with varying levels of kidney function is not known (REG-SPECT). Furthermore, the impact of varying levels of kidney dysfunction on cardiac outcomes in patients undergoing REG-SPECT has not been defined. Our objective was to evaluate the prognostic value of regadenoson stress imaging in patients with different levels of kidney dysfunction.
Methods And Results:
We followed 1107 consecutive patients who underwent REG-SPECT for a mean duration of 1.8 ± 0.8 years. CKD was defined as estimated glomerular filtration rate (GFR) 60 mL/min/1.73 m(2). Kaplan-Meier survival analysis was performed to evaluate survival, free of major adverse cardiac events (MACE). CKD patients with GFR <60 (47% male, mean age 70 years) had a higher prevalence of cardiac risk factors and a history of coronary artery disease and were on significantly more cardiac medications (P < 0.001) than those with GFR >60. Patients with GFR <60 were significantly more likely to develop adverse cardiac outcomes including congestive heart failure (CHF) (P = 0.02), cardiac death (P < 0.001), all-cause death (P < 0.001), and MACE (P < 0.001) over the period of follow-up. Cardiac death increased with worsening levels of perfusion defects (SSS) across the entire spectrum of renal function (P < 0.001). GFR <60 was an independent predictor of MACE with a hazard ratio (HR) of 1.49 (95% CI: 1.06-2.08). The presence of transient ischaemic dilation (TID) was associated with an HR of 5.06 (95% CI: 1.43-17.90).
Conclusions:
Renal function is a powerful risk predictor in patients undergoing REG-SPECT. REG-SPECT provides robust prognostication across the entire spectrum of renal function.
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