Korean J Intern Med.  2018 Jan;33(1):148-156. 10.3904/kjim.2016.116.

Long-term prognosis of end-stage renal disease patients with normal myocardial perfusion as determined by single photon emission computed tomography

• Park GH
• Song JW
• Lee CM
• Song YR
• Kim SG
• Kim HJ
• Kim JK

• KMID: 2411519
• DOI: http://doi.org/10.3904/kjim.2016.116

Abstract

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.

Keyword

Kidney failure, chronic; Normal perfusion scintigraphy; Cardiac events; Inflammation

MeSH Terms

C-Reactive Protein
Comorbidity
Coronary Artery Disease
Echocardiography
Follow-Up Studies
Humans
Hypertrophy
Inflammation
Kidney Failure, Chronic*
Perfusion*
Prognosis*
Renal Dialysis
Tomography, Emission-Computed
Tomography, Emission-Computed, Single-Photon*
C-Reactive Protein