The role of myocardial scintigraphy in the assessment of cardiovascular risk in patients with end-stage chronic kidney disease on the waiting list for renal transplantation.
BACKGROUND
The usefulness of stress myocardial perfusion scintigraphy for cardiovascular (CV) risk stratification in chronic kidney disease remains controversial. We tested the hypothesis that different clinical risk profiles influence the test.


METHODS
We assessed the prognostic value of myocardial scintigraphy in 892 consecutive renal transplant candidates classified into four risk groups: very high (aged≥50 years, diabetes and CV disease), high (two factors), intermediate (one factor) and low (no factor).


RESULTS
The incidence of CV events and death was 20 and 18%, respectively (median follow-up=22 months). Altered stress testing was associated with an increased probability of cardiovascular events only in intermediate-risk (one risk factor) patients [30.3 versus 10%, hazard ratio (HR)=2.37, confidence interval (CI) 1.69-3.33, P<0.0001]. Low-risk patients did well regardless of scan results. In patients with two or three risk factors, an altered stress test did not add to the already increased CV risk. Myocardial scintigraphy was related to overall mortality only in intermediate-risk patients (HR=2.8, CI 1.5-5.1, P=0.007).


CONCLUSIONS
CV risk stratification based on myocardial stress testing is useful only in patients with just one risk factor. Screening may avoid unnecessary testing in 60% of patients, help stratifying for risk of events and provide an explanation for the inconsistent performance of myocardial scintigraphy.
Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. jose.lima@incor.usp.br
Jose Jayme
JJ
Galvão De Lima
Luis Henrique
LH
Wolff Gowdak
Flávio Jota
FJ
de Paula
Jose Antonio
JA
Franchini Ramires
Luiz A
LA
Bortolotto
D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011300:Preoperative Care; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D014850:Waiting Lists