NDT Advance Access originally published online on February 19, 2004
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Nephrol Dial Transplant (2004) 19: 1161-1167
Nephrol Dial Transplant Vol. 19 No. 5 © ERA-EDTA 2004; all rights reserved
Original Article
Prognostic value of stress myocardial perfusion imaging using adenosine triphosphate at the beginning of haemodialysis treatment in patients with end-stage renal disease
1Division of Nephrology and 2Division of Cardiology, Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo and 3Division of Dialysis and Nephrology, Nissan Tamagawa Hospital, Tokyo, Japan
Correspondence and offprint requests to: Hiroki Hase, MD, Division of Nephrology, Third Department of Internal Medicine, Toho University Ohashi Hospital, 2-17-6 Meguro-ku, Tokyo 153-8515, Japan. Email: hiroki{at}oha.toho-u.ac.jp
Background. Non-invasive detection of coronary artery disease (CAD) remains difficult in patients with end-stage renal disease (ESRD). This study evaluated the ability of pharmacologic stress myocardial perfusion imaging to predict cardiac events in patients with ESRD.
Methods. A prospective study was carried out in 49 consecutive patients with ESRD. Thallium-201 single photon emission computed tomography (SPECT) using high-dose adenosine triphosphate (ATP) was performed within 1 month of the beginning of haemodialysis. The study end-point was a cardiac event or the 1-year anniversary of the SPECT study.
Results. Twenty-four patients (17 diabetics, 57% and seven non-diabetics, 37%) had myocardial perfusion defects. The remaining 25 patients had normal perfusion images. Fifteen patients had non-fatal cardiac events and two patients died of a cardiac cause. All patients who had non-fatal cardiac events underwent myocardial revascularization and survived until the end of follow-up. The 1-year cardiac event-free survival rate was 34% among patients with perfusion defects and 96% among patients without perfusion defects (P<0.001). The presence of a myocardial perfusion defect was the only independent predictor of 1-year cardiac events both in overall (HR, 49.91; 95% CI, 5.15–484.00; P<0.001) and in diabetic patients (HR, 33.72; 95% CI, 2.96–383.5; P = 0.005). Diabetes and an increased C-reactive protein were associated with the progression of CAD.
Conclusions. Normal myocardial perfusion imaging by stress thallium-201 SPECT using high-dose ATP performed within 1 month after the beginning of haemodialysis treatment is a powerful predictor of cardiac event-free survival in patients with ESRD.
Keywords: cardiovascular mortality; coronary artery disease; end-stage renal disease; outcome; percutaneous transluminal coronary angioplasty; prospective cohort study; scintigraphic uptake
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