Advertisement

Journal of Nuclear Cardiology

, Volume 26, Issue 1, pp 288–297 | Cite as

Prognostic value of left ventricular dyssynchrony evaluated by gated myocardial perfusion imaging in patients with chronic kidney disease and normal perfusion defect scores

  • Hiroaki Mori
  • Satoshi IsobeEmail author
  • Susumu Suzuki
  • Kazumasa Unno
  • Ryota Morimoto
  • Naoaki Kano
  • Takahiro Okumura
  • Yoshinari Yasuda
  • Katsuhiko Kato
  • Toyoaki Murohara
Original Article

Abstract

Background

This study aimed to investigate whether indices of left ventricular (LV) dyssynchrony by gated myocardial perfusion SPECT (GMPS) could be useful to predict prognosis in chronic kidney disease (CKD) patients with normal perfusion defect scores.

Methods

One hundred and sixty-seven CKD patients with normal perfusion defect scores on adenosine-stress 201Tl GMPS and no previous history of overt heart diseases were enrolled. Phase standard deviation (PSD) and bandwidth (BW) were automatically calculated from GMPS. The major adverse cardiac events (MACEs) for a mean of 560 days were defined as sudden cardiac death, fatal arrhythmias, and acute coronary syndrome requiring urgent coronary revascularization. Patients were divided into two groups according to the presence or absence of MACEs.

Results

The MACEs occurred in 12 patients (7.1%). Patients who experienced MACEs showed significantly higher PSD and wider BW than those who did not. In the Kaplan-Meier event-free survival analysis, cardiac event rate was significantly higher in the high-PSD and wide-BW group (n = 81) than in the low-PSD and narrow-BW group (n = 71) (P = .002). The multivariate regression analysis revealed that the PSD was associated with MACEs (odds ratio 1.33, 95% confidence interval 1.05-1.69, P = .01).

Conclusion

The LV dyssynchrony indices from GMPS may be novel prognostic predictors in CKD patients with normal perfusion defect scores.

Keywords

CKD gated myocardial SPECT normal perfusion defect scores phase analysis prognosis 

Abbreviations

BW

Bandwidth

CKD

Chronic kidney disease

EDV

End-diastolic volume

eGFR

Estimated glomerular filtration rate

ESV

End-systolic volume

GMPS

Gated myocardial perfusion SPECT

LVEF

Left ventricular ejection fraction

MACE

Major adverse cardiac event

PSD

Phase standard deviation

Notes

Acknowledgements

The authors thank Toshiro Fujita and Shinji Abe, radiological technicians, for technical assistance in the SPECT examination.

Disclosure

The authors declare that they have no conflict of interest and financial disclosures.

Supplementary material

12350_2017_889_MOESM1_ESM.pptx (213 kb)
Supplementary material 1 (PPTX 212 kb)

References

  1. 1.
    Eknoyan G, Lameire N, Barsoum R, Eckardt KU, Levin A, Levin N, et al. The burden of kidney disease: Improving global outcomes. Kidney Int 2004;66:1310-4.Google Scholar
  2. 2.
    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.Google Scholar
  3. 3.
    Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004;164:659-63.Google Scholar
  4. 4.
    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.Google Scholar
  5. 5.
    Hatta T, Nishimura S, Nishimura T. Prognostic risk stratification of myocardial ischaemia evaluated by gated myocardial perfusion SPECT in patients with chronic kidney disease. Eur J Nucl Med Mol Imaging 2009;36:1835-41.Google Scholar
  6. 6.
    Okuyama C, Nakajima K, Hatta T, Nishimura S, Kusuoka H, Yamashina A, et al. Incremental prognostic value of myocardial perfusion single photon emission computed tomography for patients with diabetes and chronic kidney disease. Nucl Med Commun 2011;32:913-9.Google Scholar
  7. 7.
    Henneman MM, Chen J, Ypenburg C, Dibbets P, Bleeker GB, Boersma E, et al. Phase analysis of gated myocardial perfusion single-photon emission computed tomography compared with tissue Doppler imaging for the assessment of left ventricular dyssynchrony. J Am Coll Cardiol 2007;49:1708-14.Google Scholar
  8. 8.
    Nakajima K, Kumita S, Ishida Y, Momose M, Hashimoto J, Morita K, et al. Creation and characterization of Japanese standards for myocardial perfusion SPECT: Database from the Japanese Society of Nuclear Medicine Working Group. Ann Nucl Med 2007;21:505-15.Google Scholar
  9. 9.
    Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009;53:982-92.Google Scholar
  10. 10.
    Berman DS, Kang X, Gransar H, Gerlach J, Friedman JD, Hayes SW, et al. Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis. J Nucl Cardiol 2009;16:45-53.Google Scholar
  11. 11.
    Nakae I, Hayashi H, Matsumoto T, Mitsunami K, Horie M. Clinical usefulness of a novel program “Heart Function View” for evaluating cardiac function from gated myocardial perfusion SPECT. Ann Nucl Med 2014;28:812-23.Google Scholar
  12. 12.
    Nakanishi R, Gransar H, Slomka P, Arsanjani R, Shalev A, Otaki Y, et al. Predictors of high-risk coronary artery disease in subjects with normal SPECT perfusion imaging. J Nucl Cardiol 2016;23:530-41.Google Scholar
  13. 13.
    Mazzanti M, Germano G, Kiat H, Kavanagh PB, Alexanderson E, Friedman JD, et al. Identification of severe and extensive coronary artery disease by automatic measurement of transient ischemic dilation of the left ventricle in dual-isotope myocardial perfusion SPECT. J Am Coll Cardiol 1996;27:1612-20.Google Scholar
  14. 14.
    Amann K, Neusüss R, Ritz E, Irzyniec T, Wiest G, Mall G. Changes of vascular architecture independent of blood pressure in experimental uremia. Am J Hypertens 1995;8:409-17.Google Scholar
  15. 15.
    Amann K, Breitbach M, Ritz E, Mall G. Myocyte/capillary mismatch in the heart of uremic patients. J Am Soc Nephrol 1998;9:1018-22.Google Scholar
  16. 16.
    Nishimura M, Tsukamoto K, Hasebe N, Tamaki N, Kikuchi K, Ono T. Prediction of cardiac death in hemodialysis patients by myocardial fatty acid imaging. J Am Coll Cardiol 2008;51:139-45.Google Scholar
  17. 17.
    Reddy KG, Nair RN, Sheehan HM, Hodgson JM. Evidence that selective endothelial dysfunction may occur in the absence of angiographic or ultrasound atherosclerosis in patients with risk factors for atherosclerosis. J Am Coll Cardiol 1994;23:833-43.Google Scholar
  18. 18.
    Saitoh S, Onogi F, Aikawa K, Muto M, Saiho T, Maekawa K, et al. Multiple endothelial injury in epicardial coronary artery induces downstream microvascular spasm as well as remodeling partly via thromboxane A2. J Am Coll Cardiol 2001;37:308-15.Google Scholar
  19. 19.
    Nishimura M, Hashimoto T, Tamaki N, Kobayashi H, Ono T. Focal impairment in myocardial fatty acid imaging in the left anterior descending artery area, a strong predictor for cardiac death in hemodialysis patients without obstructive coronary artery disease. Eur J Nucl Med Mol Imaging 2015;42:1612-21.Google Scholar
  20. 20.
    Dou L, Bertrand E, Cerini C, Faure V, Sampol J, Vanholder R, et al. The uremic solutes p-cresol and indoxyl sulfate inhibit endothelial proliferation and wound repair. Kidney Int 2004;65:442-51.Google Scholar
  21. 21.
    Yoshikawa D, Ishii H, Suzuki S, Takeshita K, Kumagai S, Hayashi M, et al. Plasma indoxyl sulfate and estimated glomerular filtration rate. Circ J 2014;78:2477-82.Google Scholar
  22. 22.
    Sato B, Yoshikawa D, Ishii H, Suzuki S, Inoue Y, Takeshita K, et al. Relation of plasma indoxyl sulfate levels and estimated glomerular filtration rate to left ventricular diastolic dysfunction. Am J Cardiol 2013;111:712-6.Google Scholar
  23. 23.
    Hida S, Chikamori T, Tanaka H, Igarashi Y, Chiba C, Usui Y, et al. Diagnostic value of left ventricular dyssynchrony after exercise and at rest in the detection of multivessel coronary artery disease on single-photon emission computed tomography. Circ J 2012;76:1942-52.Google Scholar
  24. 24.
    Uebleis C, Hellweger S, Laubender RP, Becker A, Sohn HY, Lehner S, et al. Left ventricular dyssynchrony assessed by gated SPECT phase analysis is an independent predictor of death in patients with advanced coronary artery disease and reduced left ventricular function not undergoing cardiac resynchronization therapy. Eur J Nucl Med Mol Imaging 2012;39:1561-9.Google Scholar
  25. 25.
    Trivedi H, Xiang Q, Klein JP. Risk factors for non-fatal myocardial infarction and cardiac death in incident dialysis patients. Nephrol Dial Transplant 2009;24:258-66.Google Scholar
  26. 26.
    Aggarwal H, AlJaroudi WA, Mehta S, Mannon R, Heo J, Iskandrian AE, et al. The prognostic value of left ventricular mechanical dyssynchrony using gated myocardial perfusion imaging in patients with end-stage renal disease. J Nucl Cardiol 2014;21:739-46.Google Scholar
  27. 27.
    Soman P, Chen J. Left ventricular dyssynchrony assessment using myocardial single-photon emission CT. Semin Nucl Med 2014;44:314-9.Google Scholar
  28. 28.
    Chen CC, Huang WS, Hung GU, Chen WC, Kao CH, Chen J. Left-ventricular dyssynchrony evaluated by Tl-201 gated SPECT myocardial perfusion imaging: A comparison with Tc-99m sestamibi. Nucl Med Commun 2013;34:229-32.Google Scholar
  29. 29.
    Nakajima K, Okuda K, Matsuo S, Kiso K, Kinuya S, Garcia EV. Comparison of phase dyssynchrony analysis using gated myocardial perfusion imaging with four software programs: Based on the Japanese Society of Nuclear Medicine Working Group normal database. J Nucl Cardiol 2016. doi: 10.1007/s12350-015-0333-y.Google Scholar
  30. 30.
    Chen J, Kalogeropoulos AP, Verdes L, Butler J, Garcia EV. Left-ventricular systolic and diastolic dyssynchrony as assessed by multi-harmonic phase analysis of gated SPECT myocardial perfusion imaging in patients with end-stage renal disease and normal LVEF. J Nucl Cardiol 2011;18:299-308.Google Scholar

Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Hiroaki Mori
    • 1
  • Satoshi Isobe
    • 1
    Email author
  • Susumu Suzuki
    • 1
    • 2
  • Kazumasa Unno
    • 1
  • Ryota Morimoto
    • 1
    • 2
  • Naoaki Kano
    • 1
  • Takahiro Okumura
    • 1
  • Yoshinari Yasuda
    • 2
    • 3
  • Katsuhiko Kato
    • 4
  • Toyoaki Murohara
    • 1
  1. 1.Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of CKD Initiatives Internal MedicineNagoya University Graduate School of MedicineNagoyaJapan
  3. 3.Division of NephrologyNagoya University Graduate School of MedicineNagoyaJapan
  4. 4.Department of Radiological and Medical Laboratory SciencesNagoya University Graduate School of MedicineNagoyaJapan

Personalised recommendations