Quantification of myocardial perfusion reserve using dynamic SPECT images of patients with chronic kidney disease

Area of Science:

• Cardiovascular imaging
• Nephrology
• Nuclear cardiology

Background:

• Chronic kidney disease (CKD) is a significant independent risk factor for cardiovascular disorders.
• Assessing subclinical cardiac dysfunction in CKD patients with normal myocardial perfusion imaging (MPI) is crucial.

Purpose of the Study:

• To investigate the relationship between renal dysfunction and quantitatively measured myocardial blood flow (MBF) and myocardial perfusion reserve (MPR).
• To determine if dynamic single-photon emission computed tomography (SPECT) parameters correlate with kidney disease in patients with normal MPI findings.

Main Methods:

• Quantitative myocardial perfusion reserve (MPR) was assessed using adenosine MPI with a cardiac cadmium zinc telluride (CZT) gamma camera in 46 CKD patients and 46 controls.
• A single tissue compartment kinetic model was employed to calculate the K1 value (perfusion rate) at stress and rest.
• MPR index was derived by dividing the stress K1 value by the at-rest K1 value.

Main Results:

• Patients with CKD exhibited a significantly higher at-rest K1 value compared to controls (0.21 vs. 0.19, p=0.040).
• The myocardial perfusion reserve (MPR) index was significantly lower in CKD patients (1.86 vs. 2.19, p<0.001).
• No significant difference was observed in stress K1 values between the groups.

Conclusions:

• A significantly lower MPR index is evident in CKD patients, suggesting impaired myocardial perfusion.
• The observed reduction in MPR is predominantly attributed to an increased at-rest K1 value in CKD.
• Quantitative SPECT analysis reveals detectable myocardial perfusion abnormalities in CKD patients despite normal overall MPI findings.