Patients with end-stage renal disease

Abstract

We investigated the role of Tc-99m sestamibi myocardial perfusion gated single photon emission computed tomography (GSPECT) in identifying those patients with end-stage renal disease (ESRD) in whom optimal diagnosis of coronary artery disease and prediction of cardiac events (CEs) could be achieved. This was a prospective study that included 41 asymptomatic ESRD patients who had been undergoing hemodialysis for 12 months or less (22 men and 19 women) with restricted selection criteria (asymptomatic traditional risk). Tc-99m sestamibi GSPECT was carried out for all patients, whereas coronary angiography (Cath) was carried out only for abnormal GSPECT patients, with a 2-year follow-up for CEs. Twenty individuals matched for age, sex, and BMI formed the control group. Of the 41 ESRD patients, 13 showed abnormal GSPECT [11/13 with myocardial perfusion defects and left ventricular dysfunction in concordance with Cath and 2/13 with only left ventricular dysfunction (i.e. stunning)] compared with 1/20 in the control group. None of the patients with negative results experienced CEs (negative predictive value 100%); these patients had a 2-year CE-free survival rate of 100% compared with 46% for patients with positive results on GSPECT (P<0.0001; seven GSPECT-positive patients developed CEs during their follow-up). Patients with positive results were more frequently male (P<0.001), were significantly older (P=0.01), and had highly sensitive C-reactive protein levels (P=0.002). Abnormal GSPECT was the only independent predictor of CEs (95% confidence interval, 7.1-46.7; hazard ratio, 46.1; P<0.001). GSPECT exhibited optimum performance for coronary artery disease detection and risk stratification in asymptomatic ESRD patients during their first year of regular hemodialysis who were selected according to our modification of the traditional risk category. This may help in selecting suitable candidates for Cath, revascularization, and future renal transplantation.