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.
OBJECTIVE
Whether myocardial perfusion imaging (MPI) can predict cardiac events in patients with advanced conservative chronic kidney disease (CKD) remains unclear.


METHODS
The present multicenter prospective cohort study aimed to clarify the ability of MPI to predict cardiac events in 529 patients with CKD and estimated glomerular filtration rates (eGFR) < 50 ml/min per 1.73(2) without a definitive diagnosis of coronary artery disease. All patients were assessed by stress-rest MPI with (99m)Tc-tetrofosmin and analyzed using summed defect scores and QGS software. Cardiac events were analyzed 1 year after registration.


RESULTS
Myocardial perfusion abnormalities defined as summed stress score (SSS) ≥4 and ≥8 were identified in 19 and 7 % of patients, respectively. At the end of the 1-year follow-up, 33 (6.2 %) cardiac events had occurred that included cardiac death, sudden death, nonfatal myocardial infarction, and hospitalization due to heart failure. The event-free rates at that time were 0.95, 0.90, and 0.81 for groups with SSS 0-3, 4-7, and ≥8, respectively (p = 0.0009). Thus, patients with abnormal SSS had a higher incidence of cardiac events. Multivariate Cox regression analysis showed that SSS significantly impacts the prediction of cardiac events independently of eGFR and left ventricular ejection fraction.


CONCLUSIONS
MPI would be useful to stratify patients with advanced conservative CKD who are at high risk of cardiac events without adversely affecting damaged kidneys.
Department of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
Nobuhiko
N
Joki
Hiroki
H
Hase
Yuhei
Y
Kawano
Satoko
S
Nakamura
Kenichi
K
Nakajima
Tsuguru
T
Hatta
Shigeyuki
S
Nishimura
Masao
M
Moroi
Susumu
S
Nakagawa
Tokuo
T
Kasai
Hideo
H
Kusuoka
Yasuchika
Y
Takeishi
Mitsuru
M
Momose
Kazuya
K
Takehana
Mamoru
M
Nanasato
Shunichi
S
Yoda
Hidetaka
H
Nishina
Naoya
N
Matsumoto
Tsunehiko
T
Nishimura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000000981:diagnostic imaging*; D058028:Research Report; D016019:Survival Analysis