The role of myocardial perfusion SPECT in short-term cardiac prognosis of end-stage renal disease

Document Type : Original Article

Authors

1 Nuclear Medicine and Molecular Imaging Research Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Nuclear Medicine, Alborz University of Medical Sciences, Karaj, Iran

3 Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Introduction: One of the most important causes of death in patients with end-stage renal disease (ESRD) and even after kidney transplantation is cardiovascular diseases. Thus, cardiac evaluation is of utmost importance in the management of these patients especially during preoperative work up before renal transplantation. The aim of present study is to evaluate the role of myocardial perfusion imaging (MPI) in short-term prognosis of cardiac events in patients with ESRD.
Methods: In this cohort study, patients with ESRD who were referred for MPI before kidney transplantation, during a two years’ time interval (December 2015- 2017) were evaluated. Those patients aged ≥30 years were included. Patients with a history of previous transplantation, congenital heart diseases, low MPI quality and incomplete /questionable history or follow-up data were excluded. The patients were subsequently followed by reviewing their hospital records, outpatient interviews and if required telephone contacts. The occurrence of cardiac related death, myocardial infarction and/or revascularization procedure was considered positive for short-term cardiac events.
Results: A total of 179 patients (67% males with mean age of 52 years) were included in this study. The mean follow-up duration was 15.3±6.6 months (2 to 32 months) during which, one hundred patients received kidney transplantation. The coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia and abnormal MPI findings were more prevalent in patients with cardiac events. Whereas those who had undergone kidney transplantation, developed fewer cardiac events during the follow up period. However, in multivariate Cox proportional hazard analysis only abnormal MPI findings and positive history of CAD were independent predictors of cardiac events. The kidney transplantation was a significantly protective marker. Other cardiac risk factors and none of quantitative perfusion parameters of MPI showed a significant association with cardiac events in multivariate Cox proportional hazard models.
Conclusion: According to our study, abnormal MPI and previous CAD history were the best predictor of short-term cardiac events. The kidney transplantation can lead to a better short-term cardiovascular prognosis.

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Main Subjects

References

  1. Delville M, Sabbah L, Girard D, Elie C, Manceau S, Piketty M, Martinez F, Méjean A, Legendre C, Sberro-Soussan R. Prevalence and predictors of early cardiovascular events after kidney transplantation: evaluation of pre-transplant cardiovascular work-up. PloS one. 2015;10(6):e0131237.
  2. Patel AD, Abo-Auda WS, Davis JM, Zoghbi GJ, Deierhoi MH, Heo J, Iskandrian AE. Prognostic value of myocardial perfusion imaging in predicting outcome after renal transplantation. Am J Cardiol. 2003;92(2):146-51.
  3. Amin A, Younis G, El-Khatib M, Ali I. Patients with end-stage renal disease: optimal diagnostic and prognostic performance of myocardial gated-SPECT, initial results. Nucl Med commun. 2013;34(4):314-21.
  4. Herzog CA, Marwick TH, Pheley AM, White CW, Rao VK, Dick CD. Dobutamine stress echocardiography for the detection of significant coronary artery disease in renal transplant candidates. Am J Kidney Dis. 1999;33(6):1080-90.
  5. Parekh RS, Carroll CE, Wolfe RA, Port FK. Cardiovascular mortality in children and young adults with end-stage kidney disease. J pediatr. 2002;141(2):191-7.
  6. Havel M, Kaminek M, Metelkova I, Budikova M, Henzlova L, Koranda P, Zadražil J, Kincl V. Prognostic value of myocardial perfusion imaging and coronary artery calcium measurements in patients with end-stage renal disease. Hellenic J Nucl Med. 2015;18(3):199-206.
  7. Dahan M, Viron BM, Faraggi M, Himbert DL, Lagallicier BJ, Kolta AM, Pessione F, Le Guludec D, Gourgon R, Mignon FE. Diagnostic accuracy and prognostic value of combined dipyridamole-exercise thallium imaging in hemodialysis patients. Kidney Int. 1998;54(1):255-62.
  8. Lentine KL, Costa SP, Weir MR, Robb JF, Fleisher LA, Kasiske BL, Carithers RL, Ragosta M, Bolton K, Auerbach AD, Eagle KA. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation: endorsed by the American Society of Transplant Surgeons, American Society of Transplantation, and National Kidney Foundation. Circulation. 2012;126(5):617-63.
  9. Beddhu S, Logar CM, Herzog CA. Diagnosis and Therapy of Coronary Artery Disease in Renal Failure, End-Stage Renal Disease, and Renal Transplant Populations. Am J Med Sci. 2003;325(4):214-27.
  10. Ahmed AM, Qureshi WT, O'Neal WT, Khalid F, Al-Mallah MH. Incremental prognostic value of SPECT-MPI in chronic kidney disease: A reclassification analysis. J Nucl Cardiol. 2018;25(5):1658-73.
  11. Jauhal A, Harenberg S, Crawford JJ, Bare I, Prasad B, Zahorski L, Ollenberger G, Trivedi V, Chopra V, Shoker A, Lavoie A. Myocardial Perfusion Scans and Mortality in Asymptomatic Patients Awaiting Renal Transplantation. Transplant proc. 2017;49(9):2011-7.
  12. Winther S, Svensson M, Jorgensen HS, Rasmussen LD, Holm NR, Gormsen LC, Bouchelouche K, Bøtker HE, Ivarsen P, Bøttcher M. Prognostic Value of Risk Factors, Calcium Score, Coronary CTA, Myocardial Perfusion Imaging, and Invasive Coronary Angiography in Kidney Transplantation Candidates. JACC Cardiovascular imaging. 2018;11(6):842-54.
  13. Doukky R, Fughhi I, Campagnoli T, Wassouf M, Ali A. The prognostic value of regadenoson SPECT myocardial perfusion imaging in patients with end-stage renal disease. J Nucl Cardiol. 2017;24(1):112-8.
  14. Helve S, Laine M, Sinisalo J, Helanterä I, Hänninen H, Lammintausta O, Lehtonen J, Finne P, Nieminen T. Even mild reversible myocardial perfusion defects predict mortality in patients evaluated for kidney transplantation. Eur Heart J Cardiovasc Imaging. 2017;19(9):1019-25.
  15. Havel M, Kaminek M, Metelkova I, Budikova M, Henzlova L, Koranda P, Lehtonen J, Finne P, Nieminen T. Prognostic value of myocardial perfusion imaging and coronary artery calcium measurements in patients with end-stage renal disease. Hell J Nucl Med. 2015;18(3):199-206.
  16. Jimenez-Heffernan A, de Mora ES, Salgado C, Lopez-Martin J, Ramos C, Rodriguez-Gomez E, Tobaruela A. Preload dependence of gated cardiac SPECT-derived ventricular volumes in hemodialysis patients. J Nucl Cardiol. 2012;19(4):743-51.
  17. Duvall WL, Slomka PJ, Gerlach JR, Sweeny JM, Baber U, Croft LB, Guma KA, George T, Henzlova MJ. High-efficiency SPECT MPI: comparison of automated quantification, visual interpretation, and coronary angiography. J Nucl Cardiol. 2013;20(5):763-73.
  18. Esteves FP, Galt JR, Folks RD, Verdes L, Garcia EV. Diagnostic performance of low-dose rest/stress Tc-99m tetrofosmin myocardial perfusion SPECT using the 530c CZT camera: quantitative vs visual analysis. J Nucl Cardiol. 2014;21(1):158-65.
  19.  Driessen RS, Raijmakers PG, Danad I, Stuijfzand WJ, Schumacher SP, Leipsic JA, Min JK, Knuuti J, Lammertsma AA, Van Rossum AC, Van Royen N. Automated SPECT analysis compared with expert visual scoring for the detection of FFR-defined coronary artery disease. Eur J Nucl Med Mol imaging. 2018;45(7):1091-100.
  20. Nakajima K, Matsuo S, Okuda K, Wakabayashi H, Tsukamoto K, Nishimura T. Estimation of Cardiac Event Risk by Gated Myocardial Perfusion Imaging and Quantitative Scoring Methods Based on a Multi-Center J-ACCESS Database. Circ J. 2011;75(10):2417-23.
  21. Ives CW, AlJaroudi WA, Kumar V, Farag A, Rizk DV, Oparil S, Iskandrian AE, Hage FG. Prognostic value of myocardial perfusion imaging performed pre-renal transplantation: post-transplantation follow-up and outcomes. Eur J Nucl Med Mol imaging. 2018;45(11):1998-2008.
  22. Nakamura S, Kawano Y, Nakajima K, Hase H, Joki N, Hatta T, Nishimura S, Moroi M, Nakagawa S, Kasai T, Kusuoka H. Prognostic study of cardiac events in Japanese patients with chronic kidney disease using ECG-gated myocardial Perfusion imaging: Final 3-year report of the J-ACCESS 3 study. J Nucl Cardiol. 2019;26(2):431-40.
  23. Crosland W, Aggarwal H, Farag A, Mehta S, Mannon RB, Heo J,  Iskandrian AE, Hage FG. The effect of renal transplantation on left ventricular function, electrocardiography, and mechanical synchrony by gated myocardial perfusion imaging. J Nucl Cardiol. 2018:1-9.

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