title: Prognostic value of myocardial perfusion imaging and coronary artery calcium measurements in patients with end-stage renal disease.
abstract: OBJECTIVE
  Coronary artery disease (CAD) is highly prevalent in patients with end-stage renal disease (ESRD), owing to clustering of traditional and uremic-specific risk factors. However, in this population asymptomatic course of CAD is common and it has been reported that myocardial perfusion imaging (MPI) with single-photon emission tomography (SPET) has lower sensitivity. In the current study, we assessed the value of MPI gated-SPET and its combination with coronary artery calcium (CAC) score measurements in risk stratification of ESRD patients.
  
  
  METHODS
  MPI gated-SPET was performed with dual-headed SPET camera and CAC score measured by multi-detector computed tomography (MDCT) system.There were tested 77 ESRD individuals. During the follow-up study, cardiac events (CE) defined as cardiac death or nonfatal myocardial infarction (MI) or the necessity for coronary revascularization were recorded. Univariate and stepwise multivariable Cox proportional hazards-models were used to identify the predictors of CE.
  
  
  RESULTS
  Eighteen CE were recorded during the follow-up. They were significantly associated with higher summed stress scores on MPI, higher percentage of ischaemic myocardium, higher occurrence of defects in multiple territories and higher CAC score (all with P<0.05). Univariate Cox proportional hazard-models showed that severe perfusion abnormalities as well as CAC score ≥1000 were significantly associated with cardiac events (P<0.0001, P=0.0056). In stepwise Cox proportional hazards-models considering age, gender, history of diabetes mellitus, post-stress left ventricular stunning, the degree of perfusion abnormality and CAC score, only severe perfusion abnormalities and CAC score ≥1000 were independent predictors of CE. There was no CE in patients with normal perfusion, normal function and zero CAC score.
  
  
  CONCLUSIONS
  This study suggests that combined evaluation of MPI and CAC can predict the outcome in ESRD individuals, while severe perfusion abnormality on gated-SPET and high CAC score ≥1000 are predictors of future cardiac events.
authors.affiliation: Department of Nuclear Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic. havel.martin@gmail.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Havel
authors.forename: Milan
authors.initials: M
authors.lastname: Kaminek
authors.forename: Iva
authors.initials: I
authors.lastname: Metelkova
authors.forename: Miroslava
authors.initials: M
authors.lastname: Budikova
authors.forename: Lenka
authors.initials: L
authors.lastname: Henzlova
authors.forename: Pavel
authors.initials: P
authors.lastname: Koranda
authors.forename: Josef
authors.initials: J
authors.lastname: Zadražil
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kincl
mesh_terms: D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000706:statistics & numerical data; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D018153:Czech Republic / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate