Skip to main content
SpringerLink
Log in

Impact of chronic kidney disease and stress myocardial perfusion imaging as a predictor of cardiovascular events

  • Original article
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

Background

Stress myocardial perfusion imaging (MPI) is an established means of predicting cardiovascular events and is suitable in chronic kidney disease (CKD) patients. We aimed to evaluate the prognostic value of CKD parameters and an abnormal stress MPI for cardiovascular events.

Methods

A total of 495 patients with suspected coronary artery disease (CAD) or history of CAD including 130 CKD patients not undergoing hemodialysis, underwent stress MPI (313 males, mean age 70 years) and were followed up for 14 months (mean period). CKD was defined as an estimated GFR of <60 ml/min/1.73 m2 and/or persistent proteinuria. Cardiovascular events were defined as sudden cardiac death, acute coronary syndrome and congestive heart failure requiring hospitalization.

Results

Cardiovascular events occurred in 41 (8.3%) patients. Multivariate Cox regression analysis indicated that CKD [hazard ratio (HR) = 3.76, p < 0.001] and a stress MPI summed difference score (SDS) of ≥2 (HR = 3.78, p < 0.001) were independent predictors of cardiovascular events; CKD plus abnormal stress MPI was also a strong predictor of cardiovascular events (non-CKD and SDS <2 vs. CKD and SDS ≥2, HR = 15.9, p < 0.001).

Conclusion

Both CKD and myocardial ischemia detected by stress MPI are independent predictors for cardiovascular events. Coexistence of CKD and myocardial ischemia detected by stress MPI is more useful for short-term risk stratification of cardiovascular events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Stress myocardial perfusion single-photon emission computed tomography is clinically effective and cost effective in risk stratification of patients with a high likelihood of coronary artery disease (CAD) but no known CAD. J Am Coll Cardiol. 2004;43:200–8.

    Article  PubMed  Google Scholar 

  2. Hachamovitch R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, et al. Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification. Circulation. 1996;93:905–14.

    PubMed  CAS  Google Scholar 

  3. Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation. 1998;97:535–43.

    PubMed  CAS  Google Scholar 

  4. Meisinger C, Doring A, Lowel H. Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population. Eur Heart J. 2006;27:1245–50.

    Article  PubMed  Google Scholar 

  5. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.

    Article  PubMed  CAS  Google Scholar 

  6. Manjunath G, Tighiouart H, Ibrahim H, MacLeod B, Salem DN, Griffith JL, et al. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol. 2004;41:47–55.

    Article  Google Scholar 

  7. Weiner DE, Tighiouart H, Amin MG, Stark PC, MacLeod B, Griffith JL, et al. Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol. 2004;15:1307–15.

    Article  PubMed  Google Scholar 

  8. Sharir T, Germano G, Kavanagh PB, Lai S, Cohen I, Lewin HC, et al. Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation. 1999;100:1035–42.

    PubMed  CAS  Google Scholar 

  9. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145:247–54.

    PubMed  CAS  Google Scholar 

  10. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1–266.

    Google Scholar 

  11. Newman AB, Shemanski L, Manolio TA, Cushman M, Mittelmark M, Polak JF, et al. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardiovascular Health Study Group. Arterioscler Thromb Vasc Biol. 1999;19:538–45.

    Article  PubMed  CAS  Google Scholar 

  12. Resnick HE, Lindsay RS, McDermott MM, Devereux RB, Jones KL, Fabsitz RR, et al. Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study. Circulation. 2004;109:733–9.

    Article  PubMed  Google Scholar 

  13. Hachamovitch R. Assessing the prognostic value of cardiovascular imaging: a statistical exercise or a guide to clinical value and application? Circulation. 2009;120:1342–4.

    Article  PubMed  Google Scholar 

  14. Nishimura T, Nakajima K, Kusuoka H, Yamashina A, Nishimura S. Prognostic study of risk stratification among Japanese patients with ischemic heart disease using gated myocardial perfusion SPECT: J-ACCESS study. Eur J Nucl Med Mol Imag. 2008;35:319–28.

    Article  Google Scholar 

  15. Berman D, Hachamovitch R, Lewin H, Friedman J, Shaw L, Germano G. Risk stratification in coronary artery disease: implications for stabilization and prevention. Am J Cardiol. 1997;79:10–6.

    Article  PubMed  CAS  Google Scholar 

  16. Berman DS, Kiat H, Friedman JD, Wang FP, van Train K, Matzer L, et al. Separate acquisition rest thallium-201/stress technetium-99 m sestamibi dual-isotope myocardial perfusion single-photon emission computed tomography: a clinical validation study. J Am Coll Cardiol. 1993;22:1455–64.

    Article  PubMed  CAS  Google Scholar 

  17. Berman DS, Hachamovitch R, Kiat H, Cohen I, Cabico JA, Wang FP, et al. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99 m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1995;26:639–47.

    Article  PubMed  CAS  Google Scholar 

  18. Galassi AR, Azzarelli S, Tomaselli A, Giosofatto R, Ragusa A, Musumeci S, et al. Incremental prognostic value of technetium-99 m-tetrofosmin exercise myocardial perfusion imaging for predicting outcomes in patients with suspected or known coronary artery disease. Am J Cardiol. 2001;88:101–6.

    Article  PubMed  CAS  Google Scholar 

  19. Hakeem A, Bhatti S, Dillie KS, Cook JR, Samad Z, Roth-Cline MD, et al. Predictive value of myocardial perfusion single-photon emission computed tomography and the impact of renal function on cardiac death. Circulation. 2008;118:2540–9.

    Article  PubMed  Google Scholar 

  20. Sarnak MJ. Cardiovascular complications in chronic kidney disease. Am J Kidney Dis. 2003;41:11–7.

    Article  PubMed  Google Scholar 

  21. Culleton BF, Larson MG, Parfrey PS, Kannel WB, Levy D. Proteinuria as a risk factor for cardiovascular disease and mortality in older people: a prospective study. Am J Med. 2000;109:1–8.

    Article  PubMed  CAS  Google Scholar 

  22. Grimm RH Jr, Svendsen KH, Kasiske B, Keane WF, Wahi MM. Proteinuria is a risk factor for mortality over 10 years of follow-up. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Kidney Int. 1997;52:S10–4.

    Article  Google Scholar 

  23. Mellbin LG, Malmberg K, Norhammar A, Wedel H, Rydén L. DIGAMI 2 Investigators. The impact of glucose lowering treatment on long-term prognosis in patients with type 2 diabetes and myocardial infarction: a report from the DIGAMI 2 trial. Eur Heart J. 2008;29:166–76.

    Article  PubMed  CAS  Google Scholar 

  24. Anselmino M, Ohrvik J, Malmberg K, Standl E, Rydén L, Euro Heart Survey Investigators. Glucose lowering treatment in patients with coronary artery disease is prognostically important not only in established but also in newly detected diabetes mellitus: a report from the Euro Heart Survey on Diabetes and the Heart. Eur Heart J. 2008;29:177–84.

    Article  PubMed  Google Scholar 

  25. Lemp GF, Vander Zwaag R, Hughes JP, Maddock V, Kroetz F, Ramanathan KB, et al. Association between the severity of diabetes mellitus and coronary arterial atherosclerosis. Am J Cardiol. 1987;60:1015–9.

    Article  PubMed  CAS  Google Scholar 

  26. Gimeno-Orna JA, Faure-Nogueras E, Castro-Alonso FJ, Boned-Juliani B. Ability of retinopathy to predict cardiovascular disease in patients with type 2 diabetes mellitus. Am J Cardiol. 2009;103:1364–7.

    Article  PubMed  Google Scholar 

  27. Matsumoto N, Sato Y, Suzuki Y, Kasama S, Nakano Y, Kato M, et al. Incremental prognostic value of cardiac function assessed by ECG-gated myocardial perfusion SPECT for the prediction of future acute coronary syndrome. Circ J. 2008;72:2035–9.

    Article  PubMed  Google Scholar 

  28. Momose M, Nakajima K, Nishimura T. Prognostic significance of stress myocardial gated SPECT among Japanese patients referred for coronary angiography: a study of data from the J-ACCESS database. Eur J Nucl Med Mol Imaging. 2009;36:1329–37.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Chihiro Hamazaki and Takeharu Ando for their technical assistance with stress myocardial perfusion imaging. We also thank Professor Eiichi Kouda for his helpful comments.

Conflict of interest

No potential conflicts of interest were disclosed.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan

    Tatsuhiko Furuhashi, Hirofumi Masai, Taeko Kunimasa, Ryo Nakazato, Hiroshi Fukuda & Kaoru Sugi

  2. Cardiology Division, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Masao Moroi

  3. Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan

    Nobuhiko Joki & Hiroki Hase

Authors
  1. Tatsuhiko Furuhashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masao Moroi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nobuhiko Joki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroki Hase
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hirofumi Masai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Taeko Kunimasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ryo Nakazato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hiroshi Fukuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kaoru Sugi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masao Moroi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Furuhashi, T., Moroi, M., Joki, N. et al. Impact of chronic kidney disease and stress myocardial perfusion imaging as a predictor of cardiovascular events. Ann Nucl Med 25, 616–624 (2011). https://doi.org/10.1007/s12149-011-0507-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12149-011-0507-x

Keywords

Search

Navigation