The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography

  • Park, Gun Ha (Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital) ;
  • Song, Jae Won (Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital) ;
  • Lee, Chang Min (Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital) ;
  • Song, Young Rim (Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital) ;
  • Kim, Sung Gyun (Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital) ;
  • Kim, Hyung Jik (Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital) ;
  • Kim, Jwa Kyung (Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital)
  • Received : 2016.04.13
  • Accepted : 2016.05.13
  • Published : 2018.01.01
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Abstract

Background/Aims: Normal myocardial perfusion is closely associated with very low rates of cardiac events and better long-term outcomes; however, little is known about its prognostic value in patients with end-stage renal disease (ESRD). Methods: A total of 286 incident patients underwent baseline cardiac evaluations using echocardiography and stress-rest single-photon emission computed tomography. Perfusion scans for 177 patients (61.9%) who had a summed stress score (SSS) < 4 were normal. Results: During the 4-year follow-up period, 79 cardiac events occurred. Patients with a SSS < 4 had significantly lower annual rates of cardiac events than did those with a SSS ${\geq}4$ (6.4% vs. 13.2%; hazard ratio, 0.54; 95% confidence interval, 0.31 to 0.94). Among patients with a SSS < 4, however, cardiac event rates significantly differed according to the presence of comorbid conditions such as old age, diabetes, history of coronary artery disease, and elevated C-reactive protein levels. In addition, the presence of left ventricular (LV) systolic dysfunction and LV hypertrophy at the start of hemodialysis strongly influenced future cardiac events. Conclusions: In patients with ESRD, normal perfusion scans usually indicate a significantly low risk of adverse cardiac events. However, even in patients with normal perfusion scans, the cardiovascular prognosis is largely dependent on baseline inflammation levels and comorbidities.

Keywords

References

  1. Tonelli M, Wiebe N, Culleton B, et al. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 2006;17:2034-2047. https://doi.org/10.1681/ASN.2005101085
  2. Mazzuchi N, Carbonell E, Fernqndez-Cean J. ESRD patients without co-morbid risk factors at the start of haemodialysis are ideal as survival comparison population. Nephrol Dial Transplant 1999;14:1091-1096. https://doi.org/10.1093/ndt/14.5.1091
  3. Kim JK, Kim SG, Kim HJ, Song YR. Cardiac risk assessment by gated single-photon emission computed tomography in asymptomatic end-stage renal disease patients at the start of dialysis. J Nucl Cardiol 2012;19:438-47. https://doi.org/10.1007/s12350-011-9497-2
  4. Hachamovitch R, Berman DS, Shaw LJ, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998;97:535-543. https://doi.org/10.1161/01.CIR.97.6.535
  5. Rabbat CG, Treleaven DJ, Russell JD, Ludwin D, Cook DJ. Prognostic value of myocardial perfusion studies in patients with end-stage renal disease assessed for kidney or kidney-pancreas transplantation: a meta-analysis. J Am Soc Nephrol 2003;14:431-439. https://doi.org/10.1097/01.ASN.0000047560.51444.3A
  6. Brown KA, Altland E, Rowen M. Prognostic value of normal technetium-99m-sestamibi cardiac imaging. J Nucl Med 1994;35:554-557.
  7. Hachamovitch R, Hayes S, Friedman JD, et al. Determinants of risk and its temporal variation in patients with normal stress myocardial perfusion scans: what is the warranty period of a normal scan? J Am Coll Cardiol 2003;41:1329-1340. https://doi.org/10.1016/S0735-1097(03)00125-6
  8. Elhendy A, Schinkel A, Bax JJ, van Domburg RT, Poldermans D. Long-term prognosis after a normal exercise stress Tc-99m sestamibi SPECT study. J Nucl Cardiol 2003;10:261-266. https://doi.org/10.1016/S1071-3581(02)43219-9
  9. Berman DS, Hachamovitch R, Kiat H, et al. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol 1995;26:639-647. https://doi.org/10.1016/0735-1097(95)00218-S
  10. Hachamovitch R, Berman DS, Kiat H, et al. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation 1996;93:905-14. https://doi.org/10.1161/01.CIR.93.5.905
  11. Hatta T, Nishimura S, Nishimura T. Prognostic risk stratification of myocardial ischaemia evaluated by gated myocardial perfusion SPECT in patients with chronic kidney disease. Eur J Nucl Med Mol Imaging 2009;36:1835-1841. https://doi.org/10.1007/s00259-009-1165-2
  12. Kato M, Matsumoto N, Nakano Y, et al. Combined assessment of myocardial perfusion and function by ECG-gated myocardial perfusion single-photon emission computed tomography for the prediction of future cardiac events in patients with type 2 diabetes mellitus. Circ J 2011;75:376-382. https://doi.org/10.1253/circj.CJ-10-0794
  13. Matsuo S, Nakajima K, Horie M, Nakae I, Nishimura T; J-ACCESS Investigators. Prognostic value of normal stress myocardial perfusion imaging in Japanese population. Circ J 2008;72:611-617.
  14. Weiner DE, Tighiouart H, Elsayed EF, et al. Inflammation and cardiovascular events in individuals with and without chronic kidney disease. Kidney Int 2008;73:1406-1412. https://doi.org/10.1038/ki.2008.75
  15. Menon V, Greene T, Wang X, et al. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int 2005;68:766-772. https://doi.org/10.1111/j.1523-1755.2005.00455.x
  16. Wanner C, Zimmermann J, Schwedler S, Metzger T. Inflammation and cardiovascular risk in dialysis patients. Kidney Int Suppl 2002;61(Suppl 80):S99-S102.
  17. Glassock RJ, Pecoits-Filho R, Barberato SH. Left ventricular mass in chronic kidney disease and ESRD. Clin J Am Soc Nephrol 2009;4 Suppl 1:S79-S91. https://doi.org/10.2215/CJN.04860709
  18. Zoccali C, Benedetto FA, Mallamaci F, et al. Left ventricular mass monitoring in the follow-up of dialysis patients: prognostic value of left ventricular hypertrophy progression. Kidney Int 2004;65:1492-1498. https://doi.org/10.1111/j.1523-1755.2004.00530.x
  19. Zoccali C, Benedetto FA, Mallamaci F, et al. Prognostic value of echocardiographic indicators of left ventricular systolic function in asymptomatic dialysis patients. J Am Soc Nephrol 2004;15:1029-1037. https://doi.org/10.1097/01.ASN.0000117977.14912.91
  20. Cerasola G, Nardi E, Palermo A, Mule G, Cottone S. Epidemiology and pathophysiology of left ventricular abnormalities in chronic kidney disease: a review. J Nephrol 2011;24:1-10.
  21. De Vriese AS, Vandecasteele SJ, Van den Bergh B, De Geeter FW. Should we screen for coronary artery disease in asymptomatic chronic dialysis patients? Kidney Int 2012;81:143-151. https://doi.org/10.1038/ki.2011.340

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