Prognostic Risk Stratification of Cardiac Events Evaluated by Aortic Calcification in Elderly Patients with Chronic Kidney Disease

Abstract

Background: The relationship between myocardial perfusion imaging (MPI) and aortic calcification (AoC) in chronic kidney disease (CKD) patients remains unclear. Methods: The Japanese Assessment of Cardiac Events and Survival Study by quantitative gated single-photonemission computed tomography (J-ACCESS 3) is a multicenter, prospective cohort study investigating the ability of MPI to predict cardiac events in 529 CKD patients. In J-ACCESS 3, the sum of myocardial perfusion defect score at stress (SSS) was a useful predictor of cardiac major events in CKD patients. However, aortic calcification was not examined. We examined the prognosis of patients with CKD according to the presence or absence of AoC using data from the J-ACCESS 3 cohort. Results: There were 60 major cardiac events (three cardiac deaths, six sudden deaths, five non-fatal myocardial infarctions, 46 hospitalization cases for heart failure). In the univariate analysis, patients with AoC had a higher left ventricular (LV) ejection fraction, smaller LV volume, and lower SSS by MPI. Kaplan-Meier curves showed a significantly higher incidence of major cardiac events in the AoC group (P=0.0041). Patients were categorized into the following four groups: Group A (non-AoC and SSS<4; normal score of 0-3); Group B (AoC and SSS<4); Group C (non-AoC and SSS≧4); Group D (AoC and SSS≧4). Kaplan-Meier curves showed that the major cardiac events rates were A<B<C<D (P=0.002). The difference was most pronounced between the AoC and no-AoC groups with SSS<4. Conclusions: The combination of SSS using MPI and AoC is a useful predictor of cardiac major events in CKD patients.

A 2-Year Prospective Study on the Differences in Prognostic Factors for Major Adverse Cardiovascular, Cerebrovascular and Renal Events Between Patients with Mild and Severe Chronic Kidney Disease

“…The present study aimed to compare differences in (15). In addition, subanalysis of the J-ACCESS database revealed a relationship between major cardiac events and perfusion SPECT findings in patients with CKD (18,19).…”

“…Although this J-ACCESS subanalysis demonstrated that SPECT had incremental value for predicting cardiac events (18,19), the study population did not include patients with endstage renal disease requiring hemodialysis and was similar to our population of patients with mild CKD. On the other hand, several studies have reported that stress myocardial perfusion SPECT is useful for detecting ischemic heart disease and predicting cardiac events in hemodialysis patients (16,20,21); the population of those studies was similar to our population of patients with severe CKD.…”

“…Studies have evaluated the prognostic value of combined stress myocardial perfusion SPECT and QGS for predicting major cardiac events (9,10,15). A number of studies have also used combined imaging to assess the prognosis of patients with CKD (16)(17)(18)(19)(20)(21)(22)(23)(24). Based on the results of these studies, scintigraphic parameters were shown to be independent predictors of cardiac events, including cardiac death, heart failure, and acute myocardial infarction.…”

Sample Size Considerations: Basics for Preparing Clinical or Basic Research

“…5, p 35(16); if "B blocker (%)" represents our treatment of interest and Aortic cal + /-our variable of interest, which provides two proportions for the B blocker and the control groups for comparison, we would set 1. Zα/2=1.…”