Shu Kasama1,2, Takuji Toyama3, Makito Sato4,5, Hirokazu Sano4,6, Tetsuya Ueda7, Toyoshi Sasaki8, Takehiro Nakahara4, Tetsuya Higuchi9, Yoshito Tsushima9, Masahiko Kurabayashi4. 1. Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-22 Showa- machi, Maebashi, Gunma, 371-8511, Japan. s-kasama@bay.wind.ne.jp. 2. Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Gunma, Japan. s-kasama@bay.wind.ne.jp. 3. Department of Cardiovascular Medicine, Gunma Prefectural Cardiovascular Center, Maebashi, Japan. 4. Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-22 Showa- machi, Maebashi, Gunma, 371-8511, Japan. 5. Department of Internal Medicine, Tatebayashi Kosei Hospital, Gunma, Japan. 6. Department of Cardiovascular Medicine, Isesaki Municipal Hospital, Isesaki, Japan. 7. Division of Cardiology, Fujioka General Hospital, Fujioka, Japan. 8. Division of Cardiology, Takasaki General Medical Center, Takasaki, Japan. 9. Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
Abstract
PURPOSE: Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. We examined whether stress myocardial perfusion single photon emission computed tomography (SPECT) provides reliable prognostic markers for these patients. METHODS: In this multicenter, prospective cohort trial from the Gunma-CKD SPECT study protocol, patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml per 1.73 m(2)] undergoing stress (99m)Tc-tetrofosmin SPECT for suspected or possible ischemic heart disease were initially followed for 1 year, with the following study endpoints: primary, the occurrence of cardiac deaths (CDs), and secondary, major adverse cardiac, cerebrovascular, and renal events (MACCREs). The summed stress score (SSS), summed rest score, and summed difference score (SDS) were estimated with the standard 17-segment, 5-point scoring model. Left ventricular end-diastolic volume, end-systolic volume (ESV), and ejection fraction were measured using electrocardiogram-gated SPECT. RESULTS: During the first year of follow-up, 69 of 299 patients experienced MACCREs (CD, n = 7; non-fatal myocardial infarction, n = 3; hospitalization for heart failure, n = 13; cerebrovascular accident, n = 1; need for revascularization, n = 38; and renal failure, i.e., hemodialysis initiation, n = 7). ESV and SSS were associated with CDs (p < 0.05), and eGFR and SDS were associated with MACCREs (p < 0.05), in multivariate logistic analysis. Patients with high ESV and high SSS had a significantly higher CD rate during the first year than the other CKD patient subgroups (p < 0.05). Patients with low eGFR and high SDS had a significantly higher MACCRE rate than the other subgroups (p < 0.05). CONCLUSION: Myocardial perfusion SPECT can provide reliable prognostic markers for patients with CKD.
PURPOSE:Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. We examined whether stress myocardial perfusion single photon emission computed tomography (SPECT) provides reliable prognostic markers for these patients. METHODS: In this multicenter, prospective cohort trial from the Gunma-CKD SPECT study protocol, patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml per 1.73 m(2)] undergoing stress (99m)Tc-tetrofosmin SPECT for suspected or possible ischemic heart disease were initially followed for 1 year, with the following study endpoints: primary, the occurrence of cardiac deaths (CDs), and secondary, major adverse cardiac, cerebrovascular, and renal events (MACCREs). The summed stress score (SSS), summed rest score, and summed difference score (SDS) were estimated with the standard 17-segment, 5-point scoring model. Left ventricular end-diastolic volume, end-systolic volume (ESV), and ejection fraction were measured using electrocardiogram-gated SPECT. RESULTS: During the first year of follow-up, 69 of 299 patients experienced MACCREs (CD, n = 7; non-fatal myocardial infarction, n = 3; hospitalization for heart failure, n = 13; cerebrovascular accident, n = 1; need for revascularization, n = 38; and renal failure, i.e., hemodialysis initiation, n = 7). ESV and SSS were associated with CDs (p < 0.05), and eGFR and SDS were associated with MACCREs (p < 0.05), in multivariate logistic analysis. Patients with high ESV and high SSS had a significantly higher CD rate during the first year than the other CKD patient subgroups (p < 0.05). Patients with low eGFR and high SDS had a significantly higher MACCRE rate than the other subgroups (p < 0.05). CONCLUSION: Myocardial perfusion SPECT can provide reliable prognostic markers for patients with CKD.
Authors: Rory Hachamovitch; Alan Rozanski; Leslee J Shaw; Gregg W Stone; Louise E J Thomson; John D Friedman; Sean W Hayes; Ishac Cohen; Guido Germano; Daniel S Berman Journal: Eur Heart J Date: 2011-01-21 Impact factor: 29.983
Authors: Guruprasad Manjunath; Hocine Tighiouart; Hassan Ibrahim; Bonnie MacLeod; Deeb N Salem; John L Griffith; Josef Coresh; Andrew S Levey; Mark J Sarnak Journal: J Am Coll Cardiol Date: 2003-01-01 Impact factor: 24.094
Authors: M Dahan; B M Viron; M Faraggi; D L Himbert; B J Lagallicier; A M Kolta; F Pessione; D Le Guludec; R Gourgon; F E Mignon Journal: Kidney Int Date: 1998-07 Impact factor: 10.612