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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

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Lung Sestamibi Uptake on Myocardial Perfusion Imaging and Outcomes in Chronic Kidney Disease

Julia Bian1, Charles A Herzog2, Janani Rangaswami3

  • 1University of South Carolina School of Medicine, Columbia, South Carolina, USA.

Cardiorenal Medicine
|January 25, 2021
PubMed

Insights

In patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), extreme lung-to-heart ratios (LHR) during cardiac stress testing indicate a higher risk of adverse outcomes. This finding may improve risk stratification in these vulnerable populations.

Area of Science:

  • Cardiology
  • Nephrology
  • Nuclear Medicine

Background:

  • Cardiac stress testing has limited accuracy for coronary artery disease in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD).
  • Novel biomarkers derived during stress testing may improve predictive capabilities for cardiovascular events in this population.

Purpose of the Study:

  • To evaluate the predictive value of the lung-to-heart ratio (LHR) in patients with CKD and ESKD undergoing cardiac stress testing.
  • To determine if LHR can enhance risk assessment for adverse cardiovascular outcomes in CKD and ESKD patients.

Main Methods:

  • A retrospective parallel cohort study included 144 CKD not on dialysis (CKD-ND) and 145 ESKD patients who underwent regadenoson sestamibi myocardial perfusion imaging.
  • Stress lung-to-heart ratio (LHR) was calculated, and patients were analyzed by LHR tertiles.
  • The primary outcome was a composite of all-cause mortality, myocardial infarction, unstable angina, or revascularization.

Main Results:

  • Patients with ESKD had a higher comorbidity burden and a higher incidence of identified ischemia compared to CKD-ND patients.
  • The primary outcome occurred more frequently in the lowest (LHR ≤0.28) and highest (LHR ≥0.33) LHR tertiles (23% and 33.3%, respectively) compared to the middle tertile (12.8%) (p = 0.005).
  • This association between extreme LHR values and adverse outcomes persisted in multivariable analysis and was consistent across both CKD-ND and ESKD groups.

Conclusions:

  • Lung-to-heart ratio (LHR) values of ≤0.28 and ≥0.33 are independently associated with an increased risk of mortality in patients with CKD and ESKD.
  • Extreme LHR values may serve as an important prognostic indicator in high-risk CKD and ESKD populations.
  • Further research is warranted to elucidate the clinical implications of extreme LHR values in these patient groups.
Abstract

Keywords:
Chronic kidney diseaseCoronary artery diseaseEnd-stage kidney diseaseLung-heart-ratioMyocardial perfusion imagingOutcomesStress testing

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