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Prognostic value of normal stress myocardial perfusion imaging and ventricular function in Japanese patients with chronic kidney disease: a study based on the J-ACCESS-3 database

Original Article
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Abstract

Background

The purpose of this study is to test the hypothesis that a normal myocardial perfusion imaging (MPI) study in chronic kidney disease (CKD) can provide benign prognostic information for the prediction of major cardiovascular events.

Methods

The study group consisted of 431 CKD patients (males, 64%; mean age, 72 ± 11 years) with normal SPECT imaging. Based on SPECT image and QGS data, 331 had a summed stress score of 3 or less, a summed difference score of 1 or less and normal cardiac function (males; end-systolic volume (ESV) ≤ 60 ml, females; ESV ≤ 40 ml, males, ejection fraction (EF) ≥ 49%; females, EF ≥ 50%).

Results

During a 3-year follow-up period, there were a total of 27 major cardiovascular events, including cardiac death (n = 3), sudden death (n = 3), and acute coronary syndrome (n = 3), and 19 were hospitalized because of congestive heart failure. Kaplan–Meier analysis showed that the number of major cardiovascular events in patients with higher eGFR of ≥ 15 ml/min) were very few, and regarded as low risk. According to the eGFR status, namely < 15 (n = 58), 15 to < 30 (n = 97), 30 to < 45 (n = 131), ≥ 45 (n = 45), the higher cardiac event rate was observed in patients with eGFR of < 15 ml/min among the four groups. The major cardiovascular event rate in patients with the lowest eGFR (< 15) was twice as much than that in patients with eGFR of ≥ 30 ml/min. Lower hemoglobin (males, < 12 g/dl; females, < 11 g/dl) and higher CRP (CPR ≥ 0.3 mg/dl) were also the predictors of increased risk.

Conclusions

Normal stress SPECT images confer a benign prognosis in patients with CKD, but care must be taken for severely reduced renal function, which was associated with higher cardiac event.

Keywords

Prognosis SPECT Radionuclide imaging Chronic kidney disease eGFR 

Notes

Acknowledgements

The J-ACCESS-3 study was supported by a grant from the Japan Cardiovascular Research Foundation. We thank the many physicians and technologists in the 62 hospitals who participated in the J-ACCESS-3 study for their cooperation.

Compliance with ethical standards

Conflict of interest

All authors have no COI.

Disclosure

None.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

References

  1. 1.
    Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risk of death, cardio vascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.CrossRefPubMedGoogle Scholar
  2. 2.
    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 Imaging. 2009;35:319–28.CrossRefGoogle Scholar
  3. 3.
    Yamasaki Y, Nakajima K, Kusuoka H, Izumi T, Kashiwagi A, Kawamori R, et al. Prognostic value of gated myocardial perfusion imaging for asymptomatic patients with type 2 diabetes: the J-ACCESS 2 investigation. Diabetes Care. 2010;33:2320–6.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Nakamura S, Kawano Y, Nakajima K, Hase H, Joki N, Hatta T, et al. Prognostic study of cardiac events in Japanese patients with chronic kidney disease using ECG-gated myocardial perfusion imaging: final 3-year report of the J-ACCESS 3 study. J Nucl Cardiol. 2017;  https://doi.org/10.1007/s12350-017-0880-5.
  5. 5.
    Joki N, Hase H, Kawano Y, Nakamura S, Nakajima K, Hatta T, et al. Myocardial perfusion imaging for predicting cardiac events in Japanese patients with advanced chronic kidney disease: 1-year interim report of the J-ACCESS 3 investigation. Eur J Nucl Med Mol Imaging. 2014;41:1701–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Nakajima K, Matsuo S, Okuda K, Wakabayashi H, Tsukamoto K, Nishimura T. Estimation of cardiac event risk by gated myocardial perfusion imaging and quantitative scoring methods based on a multi-center J-ACCESS database. Circ J. 2011;75:2417–23.CrossRefPubMedGoogle Scholar
  7. 7.
    Matsuo S, Nakajima K, Horie M, Nakae I, Nishimura T. Prognostic value of normal stress myocardial perfusion imaging in Japanese population. Circ J. 2008;72:611–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Matsuo S, Nakajima K, Yamasaki Y, Kashiwagi A, Nishimura T. Prognostic value of normal stress myocardial perfusion imaging and ventricular function in Japanese asymptomatic patients with type 2 diabetes—a study based on the J-ACCESS-2 database. Circ J. 2010;74:1916–21.CrossRefPubMedGoogle Scholar
  9. 9.
    Herzog CA, Asinger RW, Berger AK, Chartan DM, Diez J, Hart RG, et al. Cardiovascular disease in chronic kidney disease. A clinical update from kidney disease: improving global outcomes (KIDIGO). Kidney Int. 2011;80:572–86.CrossRefPubMedGoogle Scholar
  10. 10.
    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-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol. 1995;26:639–47.CrossRefPubMedGoogle Scholar
  11. 11.
    Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107:499–511.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    Hasebroock KM, Serkova NJ. Toxicity of MRI and CT contrast agents. Expert Opin Drug Metab Toxicol. 2009;5:403–16.CrossRefPubMedGoogle Scholar
  14. 14.
    Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117:1283–91.CrossRefPubMedGoogle Scholar
  15. 15.
    Matsuo S, Matsumoto T, Nakae I, Koh T, Masuda D, Takada M, et al. Prognostic value of ECG-gated thallium-201 single-photon emission tomography in patients with coronary artery disease. Ann Nucl Med. 2004;18:617–22.CrossRefPubMedGoogle Scholar
  16. 16.
    Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.CrossRefPubMedGoogle Scholar
  17. 17.
    Trikalinos TA, Alsheikh-Ali AA, Tatsioni A, Nallamothu BK, Kent DM. Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. Lancet. 2009;373:911–8.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Matsuo S, Nakajima K, Onoguchi M, Wakabayash H, Okuda K, Kinuya S. Nuclear myocardial perfusion imaging using thallium-201 with a novel multifocal collimator SPECT/CT: IQ-SPECT versus conventional protocols in normal subjects. Ann Nucl Med. 2015;29:452–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Matsuo S, Nakajima K, Okuda K, Kinuya S. The relationship between stress-induced myocardial ischemia and coronary artery atherosclerosis measured by hybrid SPECT/CT camera. Ann Nucl Med. 2011;25:650–6.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    Gibbons RJ, Hodge DO, Berman DS, Akinbonoye OO, Heo J, Hachamovitch R, et al. Long-term outcome of patients with intermediate-risk exercise electrocardiograms who do not have myocardial perfusion defects on radionuclide imaging. Circulation. 1999;23:2140–5.CrossRefGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    Wada H, Hohi T, Miyauchi K, Doi S, Naito R, Konishi H, et al. Independent and combined effects of serum albumin C-reactive protein on long-term outcomes of patients undergoing percutaneous coronary intervention. Circ J. 2017;81:1293–300.CrossRefPubMedGoogle Scholar
  25. 25.
    Underwood SR, Godman B, Salyani S, Ogle JR, Ell PJ. Economics of myocardial perfusion imaging in Europe: the EMPIRE study. Eur Heart J. 1999;20:157–66.CrossRefPubMedGoogle Scholar
  26. 26.
    Yoshinaga K. Current clinical practice of nuclear cardiology in Japan. Ann Nucl Cardiol. 2016;2:50–2.CrossRefGoogle Scholar
  27. 27.
    Matsuo S. Phase analysis using gated myocardial perfusion single-photon emission computed tomography imaging for evaluating cardiac dyssynchrony. Circ J. 2012;76:1832–3.CrossRefPubMedGoogle Scholar
  28. 28.
    Soneson H, Hedeer F, Arévalo C, Carlsson M, Engblom H, Ubachs JF, et al. Development and validation of a new automatic algorithm for quantification of left ventricular volumes and function in gated myocardial perfusion SPECT using cardiac magnetic resonance as reference standard. J Nucl Cardiol. 2011;18:874–85.CrossRefPubMedGoogle Scholar
  29. 29.
    Gimelli A, Liga R, Magro S, Novo S, Pedrinelli R, Petronio AS, et al. Evaluation of left ventricular mass on cadmium-zinc-telluride imaging: validation against cardiac magnetic resonance. J Nucl Cardiol 2017.Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Nuclear MedicineKanazawa University HospitalKanazawaJapan
  2. 2.Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
  3. 3.Department of Radiology, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan

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