Cardiac risk assessment by gated single-photon emission computed tomography in asymptomatic end-stage renal disease patients at the start of dialysis.
OBJECTIVE
This study assessed the impact of cardiac risk assessment using gated single-photon emission computed tomography (SPECT) on cardiac events in end-stage renal disease (ESRD) patients.


METHODS
We evaluated 215 asymptomatic patients who began dialysis between January 2005 and April 2009. Baseline electrocardiography and echocardiography were performed in all the patients. The subjects were stratified into low- and high-risk groups according to the baseline cardiac status, and gated SPECT was additionally recommended for the high-risk patients.


RESULTS
The study population consisted of 50 low- and 165 high-risk patients undergoing SPECT. Among the high-risk patients, 75 (45.5%) showed perfusion defects on SPECT and their overall cardiac-event rate per person-year of follow-up was 15.0%, significantly higher than 4.5% in high-risk group without perfusion defect and 1.2% in low-risk group. The presence of perfusion defect was a significant independent predictor of adverse cardiac events [hazard ratio (HR) 2.11; 95% confidence interval (CI) 1.05-4.24; P = .035]. When gated SPECT was added to the clinical and the echocardiographic variables, the prognostic stratification significantly improved (P < .001). However, coronary revascularization was not associated with improved cardiac event-free survival (HR 0.62; 95% CI 0.26-1.52; P = .296).


CONCLUSIONS
Gated SPECT may provide additional prognostic information for cardiac risk stratification, particularly among high-risk patients starting dialysis.
Department of Internal Medicine & Kidney Research Institute, Hallym University College of Medicine, Anyang-si, Korea.
Jwa-Kyung
JK
Kim
Sung Gyun
SG
Kim
Hyung Jik
HJ
Kim
Young Rim
YR
Song
D055424:Cardiac-Gated Imaging Techniques / Q000706:statistics & numerical data*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000401:mortality* / Q000517:prevention & control; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D015995:Prevalence; D006435:Renal Dialysis / Q000401:mortality*; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*