Amjad M Ahmed1, Waqas T Qureshi2, Wesley T O'Neal2, Fatima Khalid2, Mouaz H Al-Mallah3,4,5,6. 1. King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, P.O. Box 22490, Riyadh, 11426, Saudi Arabia. 2. Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA. 3. King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, P.O. Box 22490, Riyadh, 11426, Saudi Arabia. mouaz74@gmail.com. 4. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. mouaz74@gmail.com. 5. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. mouaz74@gmail.com. 6. Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA. mouaz74@gmail.com.
Abstract
BACKGROUND: Traditional cardiovascular (CV) risk factors have limited predictive value of CV mortality in patients with chronic kidney disease (CKD, creatinine clearance less than 60 mL/minute per 1.73 m2). The aim of this study was to evaluate incremental and independent prognostic value of single-photon emission computerized tomography-myocardial perfusion imaging (SPECT-MPI) across continuum of renal function. METHODS: We retrospectively studied 11,518 (mean age, 65 ± 12 years; 52% were men) patients referred for a clinical indication of SPECT-MPI between April 2004 and May 2009. Primary end point was composite of cardiac death and non-fatal myocardial infarction (CD/MI). We examined the relationship of total perfusion defect (TPD) and CD/MI in multiple Cox regression models for CV risk factors and GFR. The incremental predictive value of TPD was examined using Harrell's c-index, net reclassification index (NRI), and integrated discrimination index (IDI). RESULTS: Over a median follow-up of 5 years (25th to 75th percentiles, 3.0-6.5 years), 1,692 (14.5%) patients experienced CD/MI (740 MI and 1,182 CD). In a multivariable model adjusted for traditional CV risk factors and GFR, the presence of a perfusion defect was independently associated with increased risk of CD/MI (HR = 2.10; 95% CI 1.81, 2.43, p < .001). Using Cox regression, TPD improved the discriminatory ability beyond traditional CV risk factors and GFR [from AUC = 0.725, (95% CI 0.712-0.738) to 0.784, (95% CI 0.772-0.796), p < .0001]. Furthermore, TPD improves risk stratification of CKD patients over and above traditional CV risk factors and GFR [NRI = 14%, 95% CI (12%-16%, p < .001) and relative IDI = 60%, 95% CI (51%, 66%, p < .001)]. CONCLUSIONS: Across the spectrum of renal function, SPECT-MPI perfusion defects independently and incrementally reclassified patients for their risk of CD/MI, beyond traditional CV risk factors.
BACKGROUND: Traditional cardiovascular (CV) risk factors have limited predictive value of CV mortality in patients with chronic kidney disease (CKD, creatinine clearance less than 60 mL/minute per 1.73 m2). The aim of this study was to evaluate incremental and independent prognostic value of single-photon emission computerized tomography-myocardial perfusion imaging (SPECT-MPI) across continuum of renal function. METHODS: We retrospectively studied 11,518 (mean age, 65 ± 12 years; 52% were men) patients referred for a clinical indication of SPECT-MPI between April 2004 and May 2009. Primary end point was composite of cardiac death and non-fatal myocardial infarction (CD/MI). We examined the relationship of total perfusion defect (TPD) and CD/MI in multiple Cox regression models for CV risk factors and GFR. The incremental predictive value of TPD was examined using Harrell's c-index, net reclassification index (NRI), and integrated discrimination index (IDI). RESULTS: Over a median follow-up of 5 years (25th to 75th percentiles, 3.0-6.5 years), 1,692 (14.5%) patients experienced CD/MI (740 MI and 1,182 CD). In a multivariable model adjusted for traditional CV risk factors and GFR, the presence of a perfusion defect was independently associated with increased risk of CD/MI (HR = 2.10; 95% CI 1.81, 2.43, p < .001). Using Cox regression, TPD improved the discriminatory ability beyond traditional CV risk factors and GFR [from AUC = 0.725, (95% CI 0.712-0.738) to 0.784, (95% CI 0.772-0.796), p < .0001]. Furthermore, TPD improves risk stratification of CKDpatients over and above traditional CV risk factors and GFR [NRI = 14%, 95% CI (12%-16%, p < .001) and relative IDI = 60%, 95% CI (51%, 66%, p < .001)]. CONCLUSIONS: Across the spectrum of renal function, SPECT-MPI perfusion defects independently and incrementally reclassified patients for their risk of CD/MI, beyond traditional CV risk factors.
Authors: Scott D Solomon; Madeline M Rice; Kathleen A Jablonski; Powell Jose; Michael Domanski; Marc Sabatine; Bernard J Gersh; Jean Rouleau; Marc A Pfeffer; Eugene Braunwald Journal: Circulation Date: 2006-06-26 Impact factor: 29.690
Authors: Francesca Mallamaci; Giovanni Tripepi; Sebastiano Cutrupi; Lorenzo S Malatino; Carmine Zoccali Journal: Kidney Int Date: 2005-06 Impact factor: 10.612
Authors: D S Berman; X Kang; K F Van Train; H C Lewin; I Cohen; J Areeda; J D Friedman; G Germano; L J Shaw; R Hachamovitch Journal: J Am Coll Cardiol Date: 1998-12 Impact factor: 24.094