Key result
Perfusion defects on MPS predict ~77% greater risk of MI or mortality in ESRD patients.
Why the study?
The prognostic value of myocardial perfusion scintigraphy compared directly with dobutamine stress echocardiography was unknown in patients with end-stage renal disease without known coronary artery disease.
Does myocardial perfusion scintigraphy provide better prognostic value compared to dobutamine stress echocardiography for predicting myocardial infarction or all-cause mortality in patients with end-stage renal disease?
Cohort (n=229)
No
Does myocardial perfusion scintigraphy provide better prognostic value compared to dobutamine stress echocardiography for predicting myocardial infarction or all-cause mortality in patients with end-stage renal disease?
Effect estimate: HR 1.77 (95% CI 1.02-3.08)
p-value: p=0.043
In end-stage renal disease patients without known coronary artery disease, perfusion defects on myocardial perfusion scintigraphy are a stronger predictor of long-term all-cause mortality and myocardial infarction compared to wall motion abnormalities on dobutamine stress echocardiography.
May refine risk stratification in ESRD; leaves open whether MPS outperforms DSE prospectively.
BACKGROUND: We aimed to compare the prognostic value of myocardial perfusion scintigraphy (MPS) and dobutamine stress echocardiography (DSE) in patients with end-stage renal disease (ESRD) without known coronary artery disease. METHODS: Two-hundred twenty-nine ESRD patients who applied for kidney transplantation at our centre were prospectively evaluated by MPS and DSE. The primary endpoint was a composite of myocardial infarction (MI) or all-cause mortality. The secondary endpoint included MI or coronary revascularization (CR) not triggered by MPS or DSE at baseline. RESULTS: MPS detected reversible ischemia in 31 patients (13.5%) and fixed perfusion defects in 13 (5.7%) patients. DSE discovered stress-induced wall motion abnormalities (WMAs) in 28 (12.2%) and at rest in 18 (7.9%) patients. MPS and DSE results agreed in 85.6% regarding reversible defects (κ = 0.358; P < .001) and in 90.8% regarding fixed defects (κ = 0.275; P < .001). Coronary angiography detected relevant stenosis > 50% in only 15 of 38 patients (39.5%) with pathological findings in MPS and/or DSE. At a median follow-up of 8 years and 10 months, the primary endpoint occurred in 70 patients (30.6%) and the secondary endpoint in 24 patients (10.5%). The adjusted Cox hazard ratios (HRs) for the primary endpoint were 1.77 (95% CI 1.02-3.08; P = .043) for perfusion defects in MPS and 1.36 (95% CI 0.78-2.37; P = ns) for WMA in DSE. The secondary endpoint was significantly correlated with the findings of both modalities, MPS (HR 3.21; 95% CI 1.35-7.61; P = .008) and DSE (HR 2.67; 95% CI 1.15-6.20; P = .022). CONCLUSION: Perfusion defects in MPS are a stronger determinant of all-cause mortality, MI and the need for future CR compared with WMAs in DSE. Given the complementary functional information provided by MPS vs DSE, results are sometimes contradictory, which may indicate differences in the underlying pathophysiology.
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Bautz et al. (2021) conducted a cohort in End-stage renal disease (ESRD) without known coronary artery disease (n=229). Myocardial perfusion scintigraphy (MPS) vs. Dobutamine stress echocardiography (DSE) was evaluated on Composite of myocardial infarction (MI) or all-cause mortality (HR 1.77, 95% CI 1.02-3.08, p=0.043). Perfusion defects in myocardial perfusion scintigraphy significantly predicted the composite of myocardial infarction or all-cause mortality (HR 1.77) in end-stage renal disease patients.
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