Type of dialysis may influence the prognostic value of myocardial perfusion imaging in end stage renal disease: an observational [13N]NH3 PET/CT study

Background Patients with end-stage renal disease (ESRD) exhibit an elevated risk of cardiovascular events, with imaging-based risk stratification becoming increasingly important. This study compares the prognostic utility of [ 13 N]NH 3 PET/CT assessing myocardial blood flow (MBF), coronary flow reserve (CFR) and coronary artery calcium score (CACS) as well as 3D carotid ultrasound (for carotid plaque burden; cPB) in hemodialysis (HD) versus peritoneal dialysis (PD) patients listed for kidney transplantation. Results 41 ESRD patients (HD n = 31; PD n = 10; median follow-up 4.9 years) without known coronary artery disease underwent myocardial perfusion imaging with [ 13 N]NH 3 PET/CT, CACS, and 3D carotid ultrasound. HD patients exhibited lower myocardial stress blood flow (MBF stress ) and CFR compared to PD patients (2.67 ± 0.67 vs. 2.97 ± 0.69; p = 0.24 and 2.5 ± 0.74 vs. 3.08 ± 1.12; p = 0.07). In the HD subgroup, only MBF stress correlated inversely with CACS and cPB ( r = -0.32; p < 0.05 and r = -0.44; p < 0.05), whereas CFR did not ( r =-0.14; p = 0.47 and r = -0.14; p = 0.44). On the other hand, both MBF stress and CFR were predictive of cardiovascular events in HD patients, although the number of events was low ( n = 4). In contrast, PD patients exhibited only one single cardiovascular event in the follow-up and no significant imaging correlations were observed. Conclusions MBF stress and CFR may emerge as prognostic markers for cardiovascular events in HD patients whereas their prognostic power in PD patients remains uncertain. HD patients show more pronounced impairment in MBF stress and atherosclerotic plaque burden in the carotid artery, highlighting particularly this parameter as a prognostic marker in this group.