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Predictive value of myocardial perfusion single-photon emission computed tomography and the impact of renal function on cardiac death
Circulation, 12/04/08

Hakeem A et al. – Myocardial perfusion single-photon emission CT (MPS) provides effective risk stratification across the entire spectrum of renal function. Renal dysfunction is an important independent predictor of cardiac death in patients undergoing MPS. Renal function and MPS have additive value in risk stratifying pts with suspected coronary artery disease. Chronic kidney disease (CKD) pts have relatively less benign prognosis than pts without CKD, even in presence of a normal scan.

Methods

Review of 1652 consecutive pts who had stress MPS (32% exercise, 95% gated) for cardiac death for a mean of 2.15±0.8 yr
MPS defects defined with summed stress score (normal <4, abnormal ≥4)
Ischemia defined as summed stress score ≥4 plus a summed difference score ≥2
Scar defined as summed difference score <2 plus a summed stress score ≥4
Renal function calculated with Modified Diet in Renal Disease equation

Results

CKD (estimated glomerular filtration rate <60 mL/min-1/1.73 m-2) in 36% of pts
Cardiac death increased with worsening levels of perfusion defects across entire spectrum of renal function
Presence of ischemia independently predictive of cardiac death, all-cause mortality, and nonfatal myocardial infarction
Pts with normal MPS and CKD had higher unadjusted cardiac death event rates than pts with no CKD and normal
Both perfusion defects and CKD were independent predictors of cardiac death after adjusting for risk factors, left ventricular dysfunction, pharmacologic stress, symptom status
Both MPS and CKD had incremental power for cardiac death prediction over baseline risk factors and left ventricular dysfunction

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