Incremental prognostic value of myocardial perfusion single photon emission computed tomography for patients with diabetes and chronic kidney disease

PURPOSE: This study estimates whether myocardial perfusion single photon emission computed tomography (SPECT) can predict the prognostic risk of cardiac events among patients with diabetes and relatively mild chronic kidney disease (CKD). METHODS: Data from 2423 patients in the Japanese Assessment of Cardiac Events and Survival Study were examined. Patients were classified into group A (diabetes-, CKD-), B (diabetes-, CKD+), C (diabetes+, CKD-), and D (diabetes+, CKD+). After 3 years of follow-up, the incidence of cardiac events and the ability of myocardial perfusion SPECT to estimate prognosis were evaluated. RESULTS: A total of 119 (4.9%) events (28 cardiac deaths, 25 myocardial infarctions, and 66 severe heart failures) occurred. Each type of event occurred more frequently in CKD compared with non-CKD groups with both diabetic and nondiabetic populations. Risk was higher in patients with high summed stress scores. Risk gradually increased in nondiabetic groups according to the decrease in the estimated glomerular filtration rate and roughly consisted of two diabetic groups with a cutoff of eGFR equal to 50 ml/min. CONCLUSION: A high incidence of cardiac events is associated with CKD in both nondiabetic and diabetic patients. Summed stress scores obtained by myocardial perfusion SPECT have a highly incremental value for predicting the cardiac prognosis of patients with diabetes and CKD. These scores are useful for the risk stratification of asymptomatic patients with relatively mild renal dysfunction requiring neither dialysis nor renal transplantation.