Key result
Normal myocardial perfusion in asymptomatic patients with end-stage renal disease was associated with a significantly lower annual rate of cardiac events compared to abnormal perfusion (HR 0.54).
Why the study?
Does normal myocardial perfusion on SPECT predict a lower risk of cardiac events in patients with end-stage renal disease?
Cohort (n=286)
No
Does normal myocardial perfusion on SPECT predict a lower risk of cardiac events in patients with end-stage renal disease?
Hazard Ratio: 0.54 (95% CI 0.31–0.94)
Absolute Event Rate: 6.4% vs 13.2%
p-value: p=0.025
In ESRD patients, normal myocardial perfusion on SPECT indicates a lower risk of cardiac events, though prognosis remains dependent on baseline inflammation and comorbidities.
Supports prognostic stratification by perfusion imaging in asymptomatic ESRD; leaves open whether screening improves outcomes.
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 ≥ 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.
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Park et al. (2016) conducted a cohort in End-stage renal disease (ESRD) (n=286). Normal myocardial perfusion (Summed Stress Score < 4) vs. Abnormal myocardial perfusion (Summed Stress Score ≥ 4) was evaluated on Composite cardiac events (cardiac death or non-fatal acute coronary syndrome) (HR 0.54, 95% CI 0.31 to 0.94, p=0.025). Normal myocardial perfusion in asymptomatic patients with end-stage renal disease was associated with a significantly lower annual rate of cardiac events compared to abnormal perfusion (HR 0.54).
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