title: Prognostic value of myocardial perfusion single photon emission computed tomography for major adverse cardiac cerebrovascular and renal events in patients with chronic kidney disease: results from first year of follow-up of the Gunma-CKD SPECT multicenter study.
abstract: OBJECTIVE
  Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. We examined whether stress myocardial perfusion single photon emission computed tomography (SPECT) provides reliable prognostic markers for these patients.
  
  
  METHODS
  In this multicenter, prospective cohort trial from the Gunma-CKD SPECT study protocol, patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml per 1.73 m(2)] undergoing stress (99m)Tc-tetrofosmin SPECT for suspected or possible ischemic heart disease were initially followed for 1 year, with the following study endpoints: primary, the occurrence of cardiac deaths (CDs), and secondary, major adverse cardiac, cerebrovascular, and renal events (MACCREs). The summed stress score (SSS), summed rest score, and summed difference score (SDS) were estimated with the standard 17-segment, 5-point scoring model. Left ventricular end-diastolic volume, end-systolic volume (ESV), and ejection fraction were measured using electrocardiogram-gated SPECT.
  
  
  RESULTS
  During the first year of follow-up, 69 of 299 patients experienced MACCREs (CD, n = 7; non-fatal myocardial infarction, n = 3; hospitalization for heart failure, n = 13; cerebrovascular accident, n = 1; need for revascularization, n = 38; and renal failure, i.e., hemodialysis initiation, n = 7). ESV and SSS were associated with CDs (p < 0.05), and eGFR and SDS were associated with MACCREs (p < 0.05), in multivariate logistic analysis. Patients with high ESV and high SSS had a significantly higher CD rate during the first year than the other CKD patient subgroups (p < 0.05). Patients with low eGFR and high SDS had a significantly higher MACCRE rate than the other subgroups (p < 0.05).
  
  
  CONCLUSIONS
  Myocardial perfusion SPECT can provide reliable prognostic markers for patients with CKD.
authors.affiliation: Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-22 Showa- machi, Maebashi, Gunma, 371-8511, Japan. s-kasama@bay.wind.ne.jp.|Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Gunma, Japan. s-kasama@bay.wind.ne.jp.
authors.forename: Shu
authors.initials: S
authors.lastname: Kasama
authors.affiliation: Department of Cardiovascular Medicine, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Toyama
authors.affiliation: Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-22 Showa- machi, Maebashi, Gunma, 371-8511, Japan.|Department of Internal Medicine, Tatebayashi Kosei Hospital, Gunma, Japan.
authors.forename: Makito
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-22 Showa- machi, Maebashi, Gunma, 371-8511, Japan.|Department of Cardiovascular Medicine, Isesaki Municipal Hospital, Isesaki, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sano
authors.affiliation: Division of Cardiology, Fujioka General Hospital, Fujioka, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ueda
authors.affiliation: Division of Cardiology, Takasaki General Medical Center, Takasaki, Japan.
authors.forename: Toyoshi
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-22 Showa- machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Nakahara
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Higuchi
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Tsushima
authors.affiliation: Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-22 Showa- machi, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kurabayashi
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000000981:diagnostic imaging*; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Chronic kidney disease; Coronary artery disease; Myocardial perfusion SPECT